Vertebroplasty and kyphoplasty are minimally invasive procedures performed to treat compression fractures of the spine by stabilizing the fractured bone with a substance that works like cement. Compression fractures are often extremely painful, and can cause abnormal spine curvature that can further lead to other serious health problems. These fractures are commonly caused by osteoporosis, spinal tumors, and traumatic injury. Traditional treatments of bed rest, pain medication, and braces are slow to relieve the pain.
Symptoms of spinal compression fractures
Spinal compression fractures can be really painful. Though for many people, the pain will subside while the bone is healing. This can take up to two or three months. Other people will continue feeling pain, even if the fracture has healed.The most common signs and symptoms of compression fractures are:
- Sudden onset of severe back pain.
- Worsening of pain when standing or walking, sometimes causing immobility.
- Lying on one’s back reduces the intensity of pain.
- Difficulty and pain when bending or twisting.
- Loss of height.
- Curvature of the spine.
Sometimes a compression fracture in the spine may not cause any back pain or other symptoms. Therefore, elderly persons (especially women) need to monitor potential fractures if there is height loss, limited ability to twist and bend the back, and/or deformity that develops in the spine.
Reasons for the procedure
Treatment options for spinal compression fractures depend on several factors. The surgeon will conduct a complete physical examination and go through your medical history. Diagnostic studies (MRI, CT, bone scan) may be performed to make an evaluation of your vertebral compression fracture. Your surgeon will also determine if your spine is “stable” or “unstable” and will discuss with you all treatment options. Non-surgical options for compression fractures include over-the-counter or prescription pain relievers, bed rest, back bracing, and physical therapy. However, for people with severe, disabling pain caused by a compression fracture, vertebroplasty and kyphoplasty can relieve pain, increase mobility and reduce the use of pain medication.
Risks of the procedure
As with any surgical procedure, complications can occur. Some complications may include, but are not limited to, the following:
- Blood clots.
- Allergic reactions.
- Bone cement leakage – Cement may leak into the nerves surrounding the vertebra causing nerve pain, which may require further treatment.
- Nerve damage or spinal cord injury, which can lead to numbness or paralysis.
Before the procedure
- Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the surgery.
- You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
- Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
- Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
- Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
- If you smoke, you will be asked to stop it. People who have spine surgery and keep smoking do not heal as well. Ask the doctor for help.
- On the day of the surgery, you will likely be asked not to eat or drink 6 – 12 hours before the procedure.
- Take any medicines the doctor told you with a small sip of water.
During the procedure
Vertebroplasty usually does not require a stay in the hospital. However, kyphoplasty may require an overnight hospital stay. Generally, the surgeries follow these processes:
- You will be asked to remove clothing and given a gown to wear.
- An intravenous (IV) line will be started in your arm or hand. Additional catheters may be inserted to monitor the status of your heart and blood pressure, as well as for obtaining blood samples.
- If there is excessive hair at the surgical site, it may be clipped off.
- A catheter will be inserted into your bladder.
- To minimize pain and discomfort, you will be given either general anesthesia, which puts you to sleep, or conscious sedation. Under conscious sedation you are awake, but feel no pain and may have no memory of the procedure.
- You will be positioned on your stomach with your chest and sides supported by pillows.
- A biopsy needle is guided into the fractured vertebra under fluoroscope (a special X- ray device) guidance through a small puncture (half an inch incision) in the patient’s skin. The fluoroscopy monitor allows the surgeon to see exactly where the needle is positioned and how far it is inserted.
- Specially formulated acrylic bone cement is injected under pressure directly into the fractured vertebra, filling the spaces within the bone – with the goal of creating a type of internal cast (a cast within the vertebra) to stabilize the vertebral bone. The pressure and amount of cement injected are closely monitored to avoid leakage into unwanted areas.
- The needle is removed before the cement hardens (which it does in ten minutes).
- The small skin puncture is covered with a bandage. You are not removed from the operating table till the remaining cement mixture in the bowl hardens.
- Vertebroplasty takes an hour for each vertebra. The injection usually takes only about 10 minutes.
- A small incision is made in the back through which the surgeon places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured vertebra.
- Guided by X-ray images, the surgeon inserts a special balloon through the tube and into the vertebrae,and then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal height. The amount of height restored depends on the age of the fracture.
- The balloons are deflated and removed, leaving a space in the middle of the vertebra. Specially designed instruments are used under low pressure to fill the cavity with a cement-like material. After being injected, the pasty material hardens quickly, stabilizing the bone.
- This procedure is called kyphoplasty because it reduces unwanted kyphosis, or forward curvature, before the bone is stabilized.
- Kyphoplasty takes about one hour for each vertebra involved.
After the procedure
After vertebroplasty or kyphoplasty, you will return to the recovery area. Your blood pressure, heart rate, and respiration will be monitored, and your pain will be addressed. You’ll remain lying down for the first hour after the procedure. After 1 hour you may sit up. After 2 hours you may get up and walk. Vertebroplasty may not require a stay in the hospital. You are likely to go home the same day. You may have to take some pain medicine for a couple of days. Kyphoplasty mostly requires an overnight stay in the hospital. Patients should not drive the same day of the surgery. If they are released the same day of the surgery, they will need to be driven home from the hospital.
Aftercare at home
Before you are discharged from the hospital, your doctor and other members of the hospital staff will give you additional self-care instructions for you to follow at home.
- Take it easy the first 24 hours after the procedure. Gradually return to your normal activities. An exercise program of gentle stretching, conditioning, and strengthening may be prescribed.
- Strenuous exertion, such as heavy lifting, should be avoided for at least six weeks.
- Maintain a correct posture/ neutral spine while you stand, sit, sleep, and lift.
- Keep the incision covered and dry for 24 hours. Afterwards you may shower, and gently pat dry the dressing that may cover the incision.
- Inform your doctor if you have fever or if the incision begins to show signs of infection, such as redness, swelling, pain, or drainage, or if you experience difficulty walking or bowel or bladder problems.
Patients can return to their normal activities 24 hours after vertebroplasty and/or kyphoplasty, except for heavy lifting and other strenuous work. These should be avoided till six weeks after surgery to expedite the recovery process. Most regular medications can be resumed 24 hours after surgery. There may be some soreness for a few days at the puncture site which may be relieved with an ice pack.
Both vertebroplasty and kyphoplasty procedures result pain reduction and increased ability to move, which significantly improves the patients’ quality of life. Kyphoplasty is considered to be potentially more helpful in correcting vertebral collapse and wedging if it is done within 6-8 weeks of when the fracture is sustained.