Vertebroplasty & Kyphoplasty

Vertebroplasty and kyphoplasty are used to treat painful vertebral compression fractures in the spine, most often the result of osteoporosis.

Typically, vertebroplasty and kyphoplasty are recommended after less invasive treatments, such as bed rest, a back brace or pain medication, have been ineffective. Vertebroplasty and kyphoplasty can be performed immediately in patients with problematic pain requiring hospitalization or for conditions that limit bed rest and pain medications.

Vertebroplasty and kyphoplasty are also performed on patients who:

• are elderly or frail and will likely have impaired bone healing after a fracture
• have vertebral compression due to a malignant tumor
• suffer from osteoporosis due to long-term steroid treatment or a metabolic disorder

Vertebroplasty and kyphoplasty should be completed within eight weeks of the acute fracture for the highest probability of successful treatment.

A clinical evaluation will be performed to confirm the presence of a compression fracture that may benefit from treatment with vertebroplasty or kyphoplasty. The evaluation may include:

• diagnostic imaging
• blood tests
• a physical exam
• spine x-rays
• radioisotope bone scan
• magnetic resonance imaging (MRI)
• computed tomography (CT)

You may be given bone-strengthening medication during treatment.

Tell your doctor about all the medications you take, including herbal supplements. List any allergies, especially to local anesthetic, general anesthesia, or contrast materials. Your doctor may tell you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners before your procedure. Tell your doctor about recent illnesses or other medical conditions. You will need to have blood drawn for tests prior to the procedure to determine if your blood clots normally.

On the day of the procedure, you should be able to take your usual medications with sips of water or clear liquid up to six hours before the procedure. You should avoid drinking juice, cream and milk. Follow your doctor’s instructions.

In most cases, you should take your usual medications, especially blood pressure medications. Take these with sips of water on the morning of your procedure. Other than medications, your doctor may tell you to not eat or drink anything for several hours before your procedure. Plan to have someone drive you home after your procedure. The nurse will give you a gown to wear during the procedure.

Vertebroplasty involves injecting the bone with a cement mixture to fuse the fragments, strengthen the vertebra and provide pain relief. First, the skin is numbed with a local anesthetic. Then, using imaging guidance, the hollow needle or trocar is passed through the skin into the vertebral body for injection of the cement mixture into the vertebra.

In kyphoplasty, after numbing the skin locally, a balloon is inserted through the trocar into the fractured vertebra where it is inflated to create a cavity for cement injection. The balloon is removed prior to injecting cement into the cavity that was created by the balloon.

Image-guided, minimally invasive procedures such as vertebroplasty and kyphoplasty are most often performed by a specially trained interventional pain physician, radiologist or neuroradiologist in an interventional radiology or neuroradiology suite, or occasionally in the operating room. This procedure is often done on an outpatient basis.

A nurse or technologist will insert an intravenous (IV) line into a vein in your hand or arm to administer a sedative. This procedure may use moderate sedation. It does not require a breathing tube. However, some patients may require general anesthesia. Your doctor may provide medications to help prevent nausea and pain and antibiotics to help prevent infection. You will be positioned lying face down for the procedure. The area through which the hollow needle, or trocar, will be inserted will be shaved, sterilized with a cleaning solution and covered with a surgical drape. A local anesthetic is then injected into the skin and deep tissues, near the fracture. The doctor will make a very small skin incision at the site. Using x-ray guidance, the trocar is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra.

In vertebroplasty, the orthopedic cement is then injected. Medical-grade cement hardens quickly, typically within 20 minutes. The trocar is removed after the cement is injected.

In kyphoplasty, the balloon tamp is first inserted through the needle and the balloon is inflated, to create a hole or cavity. The balloon is then removed and the bone cement is injected into the cavity created by the balloon.

X-rays and/or a CT scan may be performed at the end of the procedure to check the distribution of the cement. The doctor applies pressure to prevent any bleeding and covers the opening in the skin with a bandage. No sutures are necessary. This procedure is usually completed within one hour. It may take longer if more than one vertebral body level is being treated. The doctor or nurse will remove your IV line before you go home.

• Vertebroplasty and kyphoplasty can increase a patient’s functional abilities and allow return to the previous level of activity without any form of physical therapy or rehabilitation.
• These procedures are usually successful at alleviating the pain caused by a vertebral compression fracture; many patients feel significant relief almost immediately or within a few days. Many patients become symptom-free.
• Following vertebroplasty, about 75 percent of patients regain lost mobility and become more active, which helps combat osteoporosis. After the procedure, patients who had been immobile can get out of bed, and this can help reduce their risk of pneumonia. Increased activity builds more muscle strength, further encouraging mobility.
• Usually, vertebroplasty and kyphoplasty are safe and effective procedures.
• No surgical incision is necessary—only a small nick in the skin that does not need stitches.

• Any procedure that penetrates the skin carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
• A small amount of orthopedic cement can leak out of the vertebral body. This does not usually cause a serious problem, unless the leakage moves into a potentially dangerous location such as the spinal canal or the blood vessels of the lungs.
• Other possible complications include infection, bleeding, increased back pain and neurological symptoms such as numbness or tingling. Paralysis is extremely rare.
• Approximately 10 percent of patients may develop additional compression fractures after vertebroplasty or kyphoplasty. When this occurs, patients usually have relief from the procedure for a few days but develop recurrent pain soon thereafter.
• There is a low risk of allergic reaction to the medications.