Kyphoplasty - Uses, Procedure, Benefits, Risks and Limitations

What Is Kyphoplasty?

Vertebrae make the backbone of our body, also known as the spine. The spine is a vital body part as it supports and stabilizes the entire body. A vertebral compression fracture could result from weak bones, as seen in osteoporosis or bone cancer. This weakness in the bone could result in vertebral collapse and any form of physical strain such as sneezing, coughing, or lifting heavy objects that could result in a fracture. It can also be caused by a direct injury. A fracture in the vertebrae could result in severe consequences such as severe pain, reduced or complete loss of function, difficulty in breathing, decreased physical activity, and depression. Hence, prompt and accurate management is crucial to restoring the functions and thereby an improved quality of life.

Kyphoplasty is a minimally invasive surgical management used to treat compression vertebral fractures. Kyphoplasty helps alleviate pain, stabilizes the vertebra, and also helps in restoring the vertebral height loss due to compression fracture. In this procedure, the fractured bone is held together using a bone cement called polymethylmethacrylate. Once the cement hardens, it strengthens the vertebra and stabilizes it.

Where Is Kyphoplasty Used?

Kyphoplasty is usually indicated in pain associated with vertebral fractures alone and not with any other conditions such as disc herniation or arthritis, or other spinal problems. It is used under the following conditions:

• Vertebral compression fracture associated with osteoporosis.

• Vertebral fracture due to metastatic or primary bone cancer.

• Vertebral vascular tumor.

• When palliative measures such as rest, back bracing, and medications have proved ineffective.

What Are the Instructions for the Patients Before the Procedure?

• Kyphoplasty procedure is most effective when done within the first week of a fracture, as with time, the bone may harden and heal but in a collapsed position.

• A physical examination and diagnostic imaging will be required to confirm the presence of a fracture.

• The doctor may take a complete history and evaluate the patient clinically to check the stability of the spine.

• X-rays, computed tomography (CT), and magnetic resonance imaging (MRI) may be required to assess the extent of damage caused.

• A bone scan may be required in patients with osteoporosis.

• The patient should disclose any history of allergy to medications, latex, or general anesthesia.

• Patients should inform the doctor regarding the medications, supplements, and over-the-counter drugs taken by them.

• Patients may be advised to stop non-steroidal anti-inflammatory drugs such as Ibuprofen and blood thinners, including Aspirin, a week before the surgery.

• Presurgical blood tests may be required.

• Smoking and drinking alcohol must be stopped a week before the surgery.

• Patients should not eat or drink for six hours before the procedure. Medications can be taken with sips of clear liquid.

• The patient can wear loose and comfortable clothes. They should remove any jewelry and accessories before the procedure.

How Is the Procedure Done?

• Kyphoplasty is an outpatient procedure performed by an interventional radiologist or a neuroradiologist.

• Each vertebral body may take an hour for the procedure to complete.

• The patient will be given a hospital gown to wear and will be taken to the surgical room.

• The patient would be asked to lie face down on the examination table. Blood pressure, heart rate, and oxygen levels would be monitored.

• An intravenous (I.V) line would be established in the arm, and a mild sedative would be administered through it along with other medications.

• The treatment site would be cleaned, shaved, and sterilized with an antiseptic solution.

• The area may be anesthetized using a local anesthetic.

• A half-inch incision will be made on the skin at the site, and a hollow needle, also known as a trocar, will be inserted through the incision with the help of a fluoroscope.

• The needles will be advanced to the site at an angle to avoid the spinal cord.

• Once the needle is in place, an inflatable balloon will be inserted through the needle into the fracture site.

• The balloon would then be inflated to create space and thereby increase the height of the collapsed vertebra.

• The balloon is then removed, and bone cement, namely polymethylmethacrylate, is injected into the cavity created by inserting the balloon.

• The cement usually hardens in 20 minutes, after which X-rays or CT may be done to confirm its position and to check for any leakage.

• The needle should be withdrawn before the cement hardens. Steri-strips or bandages will be used to close the incision site. No sutures will be required.

• The patient will be monitored for at least two hours after the procedure in the recovery room.

What Are the Instructions After the Procedure?

• After the procedure is complete, patients will have to lie down for the first hour, and then after an hour, they may sit up. After two hours, the patient may be mobilized and asked to walk.

• The patient may find immediate pain relief at least within two days of the procedure.

• However, they might be asked to rest for 24 to 48 hours.

• Patients can return to their normal activities, although heavy strenuous physical activities should be restricted for six weeks.

• No driving for two to three days.

• No smoking and alcohol for two weeks after the procedure.

• Do not bend or twist the back.

• Initially, walk for five to ten minutes every three to four hours, and then gradually, it can be increased.

• Blood thinners and other medications may be resumed with the doctor’s advice.

• Certain medications and supplements may be suggested by the doctor to strengthen the bone and prevent any further fracture.

• An ice pack may be used to relieve the soreness caused by the needle. Use it for 15 minutes hourly.

• While taking a bath, ensure the bandage is kept dry for 48 hours after the procedure.

• Ensure to dress the incision site.

When to Seek Medical Advice?

• High temperature.

• Uncontrolled pain.

• Bleeding or discharge from the incision site.

• Weakness in the extremities or the back.

• Difficulty while passing urine or while bowel movement.

• Difficulty in breathing.

What Are the Benefits of This Procedure?

• Greatly improves patient’s functional abilities.

• Pain relief is obtained immediately or a few days after the procedure.

• Better patient movement within 48 hours of this procedure.

• Positive patient outcome.

• Minimally invasive procedure.

• Well tolerated by the patients.

What Are the Risks of This Procedure?

• There are minimal chances of infection, bleeding, or the pain increases after the surgery.

• Weakness or numbness is associated with nerve damage.

• Leakage of the cement out of the site. Leakage is potentially harmful only when it enters the spinal canal or lung circulation. It can also cause cord compression if leaked into the spinal canal.

• Allergic reaction to the medications used.

What Are the Limitations of This Procedure?

Kyphoplasty is contraindicated in the following conditions:

• When the pain is associated with disc problems, arthritis, stenosis, or cord compression.

• When the vertebral fracture is stable and not painful.

• Infection of the bone such as osteomyelitis.

• History of allergic disorder.

• Not recommended in patients with severe lung disease as they might not be able to lie with their face down for an hour or two that kyphoplasty requires.

• Healed fractures.

• Not recommended in scoliosis or kyphosis caused by reasons other than osteoporosis.

• Tumor in the spinal canal.

• Ladies who might be pregnant.

• Fractured bony fragment impinging the spinal canal.

What Is the Difference Between Vertebroplasty and Kyphoplasty?

Conclusion:

Kyphoplasty is a safe and effective treatment procedure for vertebral compression fractures. Studies have proven that most fractures would heal by themselves with time, however, in a compromised manner. Hence it is advocated that kyphoplasty be conducted within the first few weeks (maximum by eight weeks) of the fracture for a successful outcome. Kyphoplasty provides immediate pain relief and improves the patient's mobility considerably, thereby improving their quality of life.