Kyphoplasty is a minimally invasive treatment for thoracic and lumbar compression fractures.
It is performed percutaneously or through the skin under light sedation. It is an outpatient procedure reserved for patients for have failed conservative treatments such as bracing and active rest. The procedure entails injecting a bio-compatible cement into the fractured vertebrae under x-ray guidance.
- This procedure starts with a small (1 cm) incision in either the thoracic or lumbar region. The incision is either right of left of midline. Sometimes, incisions are made on both sides of the spine (at the surgeon’s discretion).
- A Jamshidi needle (large bore) is inserted into the pedicle of the fractured bone, using it as a bony channel to provide access to the vertebral body.
- Through the hollow center of the Jamshidi needle, the surgeon passes a semi-rigid balloon-tipped catheter, guiding it into place under fluoroscopy (x-ray). Typically, the balloon is advanced into the anterior (forward) portion of the fractured vertebral body.
- [A second balloon-tipped catheter may be similarly introduced into the other side (half) of the fractured vertebral body via the second incision.]
- The balloon is gradually inflated by the surgeon and creates a cavity within the bone. Sometimes the vertebral body height is restored during this procedure (akin to a jack inflating a tire).
- The balloon-tipped catheter is then removed and cement is injected (via a cannula) into the cavity under fluoroscopic guidance.
- The cement is allowed to cure for several minutes after which the Jamshidi (introducer needle) is removed.
- The skin is closed with a single suture or steri-strips.
- Patients typically are discharged home the same day in a brace.
WHAT YOU WANT TO KNOW
“How long does a kyphoplasty take to perform?”
A single level kyphoplasty (with single or dual balloons) takes approximately 20 minutes. It is typically performed under IV sedation; the skin is anesthetized at the incision site(s).
“Is everyone with a compression fracture a kyphoplasty candidate?”
No. Patients with severe compression fractures (and resultant neurologic problems/deformity) typically undergo fusion surgery. Those with stable compression fractures who are initially managed with a brace and fail to improve from a pain standpoint may be offered kyphoplasty. The procedure is not offered to patients with chronic (longstanding) fractures, those with significant bony retropulsion (fracture fragments within the spinal canal) or those with significant kyphotic deformity. Kyphoplasty is not a substitute for fusion surgery as the injected cement bears little structural integrity and strength.
“What is the success rate of kyphoplasty?”
Quoted success rates vary but can be upward of 90%. There are many patients who respond dramatically to kyphoplasty with near complete resolution of pain immediately postoperatively. Some patients remain unchanged in the wake of the procedure.
“Who typically develops compression fractures? Should I be concerned?”
Osteoporotic patients (those with weak bones) are at increased risk for the development of compression fractures. Smokers, post-menopausal women, those with vitamin D3 deficiency and patients with cancer, to name a few, are at increased risk for fractures. The best treatment is prevention. Osteoporosis is a preventable age-related disease.
“My friend had ‘cancer in the bones’ and had cement injected. Is this the same thing?"
Yes, kyphoplasty may be indicated in patients with so-called pathologic fractures (fractures associated with cancerous involvement of the bone and resultant weakening). Cement is injected into the affected bone, bolstering its integrity and reducing pain.