What is a Kyphoplasty?

KYPHOPLASTY

Kyphoplasty refers to a surgical procedure that helps to treat spinal compression fractures. Spinal compression fractures primarily occur in the weakened spinal vertebrae due to osteoporosis or trauma. Patients with osteoporosis can experience compression fractures in the thoracic region of their spine, at any level between T1 and T12 vertebrae, but may also occur in the lumbar region, at the level between L1 to L5 1. Kyphoplasty helps to reduce the pain, stabilize and restore the vertebra back to its normal height. This comprises a minimally invasive percutaneous procedure that inserts an inflatable bone tamp into the fractured vertebral body.

Kyphoplasty and vertebroplasty use a similar technique that involves injecting acrylic bone cement into the fracture through a hole in the skin. Kyphoplasty helps to restore the height of vertebrae by addressing the curvature of the spine. That’s the only difference between kyphoplasty and vertebroplasty. The restoring procedure involves inflating a small balloon into the vertebrae for creating space before injecting the bone cement. That’s why neurosurgeons also refer to this process as balloon kyphoplasty. According to the Journal of Spine Surgery. Neurosurgeons performed almost 19,420 kyphoplasty procedures in the USA in 2014.

What are the conditions for a Kyphoplasty?

Neurosurgeons might recommend kyphoplasty for patients with kyphosis, severe back or neck pain, certain spinal fractures, or cancer-damaged vertebrae. In most cases, a weakening of the bones causes loss of bone density, resulting in the vertebrae to compress or collapse. This causes great pain and hunched posture. Neurosurgeons never use this process as a preventive technique, even for osteoporosis, and not advise for back arthritis, herniated discs, or curvature of the spine due to scoliosis.

Neurosurgeons will not recommend kyphoplasty to correct an established deformity of the spine or certain patients who have had osteoporosis for a long time 3. Neurosurgeons suggest potential candidates to complete kyphoplasty within 8 weeks of when the fracture occurs to get the highest probability of restoring height.

What are the different Types of Kyphoplasty Procedures?

According to the location of spinal fracture, neurosurgeons can perform kyphoplasty in the vertebrae of different regions such as cervical, thoracic, and lumbar. Cervical kyphoplasty performs when this operation involves restoring the spinal fractures in the cervical vertebrae. Similarly, thoracic and lumbar kyphoplasty performs when the spinal fracture occurs in the thoracic and lumbar vertebrae, respectively.

What are the Risks associated with a Kyphoplasty Surgery?

All surgical operation has some level of risk. Similar to other surgical procedures, kyphoplasty has some general risks of operation such as reaction to anesthesia, infection, excessive blood loss, congestion, and hematoma, stroke, heart attack, etc. A study reported that, after kyphoplasty or vertebroplasty, the incidence of more compression fracture increases in about 10 percent of patients. Other specific risks of kyphoplasty procedure may include 4:

  • Nerve damage or spinal cord injury occurs due to the mal-positioned instruments set in the back. This nerve damage leads to numbness, weakness, or tingling in the arm, back, etc.
  • Nerve injury or spinal cord compression occurs due to the leakage of the PMMA into the veins or epidural space.
  • In some cases, an allergic reaction may happen due to the solution used as it inflates to see the balloon on the X-ray image.

How should a patient prepare for a Kyphoplasty procedure?

Patients need to discuss with their neurosurgeon about their qualifications for the kyphoplasty procedure. Neurosurgeons will perform some blood tests before the day of surgery. They will advise not to take any medicines like blood thinners before the time of operation. Patients need to avoid eating and drinking food for at least 12 hours before the surgery.

Just before surgery, neurosurgeons will perform additional imaging tests like X-ray or magnetic resonance imaging (MRI)to see the area or areas that need repair. In preparation, an anesthesiologist will place an intravenous line (IV) in the patient’s arm to deliver the general anesthesia. Patients will also receive pain-killer and anti-nausea medications with antibiotics to prevent secondary bacterial infection.

How does a Spinal Specialist perform a Kyphoplasty?

A professional medical team requires to perform the kyphoplasty successfully. This team should comprise a well-trained neurosurgeon, an anesthesiologist, and a nurse to assist. The overall procedure includes 5:

  • Patient will lie on their belly on the operation table.
  • Anesthesiologists will give general anesthesia to fall asleep so that patient will not feel any pain or sensation throughout the operation.
  • Neurosurgeons will make a small incision in the back through which they place a narrow tube.
  • Using fluoroscopy, neurosurgeons will guide the tube to create a path through the back into the fractured area.
  • With X-ray guidance, neurosurgeons will insert a balloon through the tube and into the vertebrae and gently inflate it.
  • This will help to elevate the fracture and helps to return the pieces to their normal position.
  • Then, the neurosurgeon will remove the balloon and fill the cavity by injecting a cement-like material called polymethylmethacrylate (PMMA). This helps to harden and stabilize the bone quickly.
  • Finally, neurosurgeons will close the incision and let the patient stay for 5 minutes to harden cement materials.

How long does a Kyphoplasty procedure typically take?

The entire procedure of kyphoplasty usually takes about one hour for each vertebra involved. During the operation, the surgical team will monitor and evaluate the patient’s heart rate, respiration, blood pressure, blood oxygen level, etc. Neurosurgeons will observe closely about the possible complication during and after the operation.

What does recovery from Kyphoplasty look like?

Most patients can go home the same day after the operation. However, neurosurgeons recommend spending one day in the hospital after the kyphoplasty procedure. Patients should not drive themselves until doctors gave the approval. This procedure relieves pain immediately for some patients. Mostly, elimination or reduction of pain occurs after 2 days. Patients can get back their normal daily activities after 6 weeks of the operation. Patients need to see their neurosurgeon if any emergency occurs or if they need to review their treatment plan for osteoporosis. Neurosurgeons suggest taking certain vitamins, minerals, and medications to strengthen the bones and prevent additional spinal fractures.

If considering a Kyphoplasty Procedure in Tarrant County, Johnson County, Ellis County or Dallas County, you should consider speaking to one of our Highly skilled, fellowship-trained Neurosurgeons Today!

References

  1. Wang, B., Zhao, C. P., Song, L. X. & Zhu, L. Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: A meta-analysis and systematic review. J. Orthop. Surg. Res. 13, 1–8 (2018).
  2. Chen, C. et al. Safety and efficacy studies of vertebroplasty, kyphoplasty, and mesh-container-plasty for the treatment of vertebral compression fractures: Preliminary report. PLoS One 11, 1–14 (2016).
  3. Pumberger, M. et al. Kyphoplasty Restores the Global Sagittal Balance of the Spine Independently from Pain Reduction. Sci. Rep. 10, 2–7 (2020).
  4. Meyer, C. et al. Kyphoplasty of Osteoporotic Fractured Vertebrae: A Finite Element Analysis about Two Types of Cement. Biomed Res. Int. 2019, (2019).

Coumans, J. V. C. E., Reinhardt, M. K. & Lieberman, I. H. Kyphoplasty for vertebral compression fractures: 1-Year clinical outcomes from a prospective study. J. Neurosurg. 99, 44–50 (2003).