Vertebroplasty-Kyphoplasty Q&A

Vertebroplasty and kyphoplasty are minimally invasive, nonsurgical procedures used to treat vertebral compression fractures of the spine. Painful, wedge-shaped fractures can be caused by osteoporosis, cancer metastasis or trauma and injury. Left untreated, they can lead to pain and increase risk of further fracturing. By restoring the vertebra height and injecting cement into the fractured bone, patients can recover faster and reduce the risk of future fractures.

What is it?

With vertebral compression fractures, the vertebral body collapses onto itself producing a "wedged" vertebra. Kyphoplasty/vertebroplasty are ways of treating vertebral body compression fractures, which are small breaks in the thick mass of bone that makes up the front part of your spinal column. Vertebral body fractures lead to the collapse or compression of a vertebra, causing your spine to shorten and curve forward. This can result in pain and a kyphotic (hunched-over) deformity. If untreated, risk of fracturing other vertebrae adjacent to the affected level increases.

When several vertebrae become wedge-shaped, people can develop a humped spine, called kyphosis. People with bones weakened by osteoporosis where there is a depletion of calcium, multiple myeloma, cancer of the bone marrow, are especially prone to compression fractures. Activities, such as lifting a heavy object, sneezing, or coughing may cause fractures. Vertebral compression fractures can lead to back pain, reduced physical activity, depression, loss of independence, decreased lung capacity, and difficulty sleeping.

How does it work?

Vertebroplasty and kyphoplasty are similar procedures. Both are performed through a hollow needle that is passed through the skin of your back into the fractured vertebra. In vertebroplasty, bone cement is injected through the hollow needle into the fractured bone. In kyphoplasty, a balloon is first inserted and inflated to expand the compressed vertebra before filling the space with bone cement. The procedures are repeated for each affected vertebra. The cement-strengthened vertebra allows you to stand straight, reduces your pain, and prevents further fractures.

The procedures are generally done under moderate sedation or monitored anesthesia care, in an X-ray suite or an operating room.

• The patient is positioned face down (prone), which may improve the overall vertebral alignment as compared to standing if the fracture is relatively acute and unstable.
• A thin needle cannula is placed into the vertebra using X-ray guidance.
• A bone cement is injected under pressure directly into the fractured vertebra.
• Once in position, the cement hardens in about 10 minutes, congealing the fragments of the fractured vertebra and providing immediate stability.
  

In this vertebral augmentation procedure, the material is placed directly into the fracture site to attempt to stabilize the site. The cement injected moves between the fracture fragments and binds them together in position. Without treatment, the fractures will eventually heal, but in a collapsed position. The benefit of vertebroplasty/kyphoplasty is that your vertebra is returned to normal position before the bone hardens. Studies show that people who get one osteoporotic fracture are 5 times more likely to develop additional fractures and this risk has been shown to decrease after vertebroplasty or kyphoplasty.It is important that people seek treatment for compression fractures early before it fully heals and more fractures occur.

What are the advantages?

Patients with severe pain and functional disability from compression fractures who have failed treatment with bracing and analgesia are good candidates for vertebroplasty / kyphoplasty. After the bone cement is inserted into the vertebra (vertebroplasty), 75% of patients are often active again.

Kyphoplasty/vertebroplasty is relatively low-risk. To be a candidate for a kyphoplasty/vertebroplasty, your pain must be related to the vertebral fracture, and must not be due to other problems, such as disk herniation, arthritis, or stenosis (narrowing). Imaging tests — such as spinal x-rays, bone scans and computed tomography (CT) or magnetic resonance imaging (MRI) scans — might be ordered to confirm the presence of a vertebral fracture. If you have osteoporosis, Texas Pain Intervention Clinic may order a dual energy x-ray absorptiometry (DEXA) scan.

With the procedure, there is a slight chance you could get an infection, bleeding, increased back pain or numbness and tingling. If you have osteoporosis, there is a risk of developing additional fractures at other vertebral bodies in your spine. To avoid this risk, our medical team will want to ensure that you are on medications to improve your bone density.