Kyphoplasty is used to treat fractures in the bones of the spine. These bones are called vertebrae, and they are the "building blocks" of your spine.
During kyphoplasty, the doctor first inflates a balloon-like device in the bone to make space. A dilating device known as an osteotome can be used instead of a balloon. The space is then filled with a cement-like material to make it more stable.
Indications for the procedure:
Certain types of fractures, or broken areas, in your spinal vertebrae may require kyphoplasty. Osteoporosis—or thinning of the bones—is the most likely cause of these fractures. The bones collapse or become compressed when a fracture occurs. The fractures result in pain and may lead you to develop a "hunch back" posture. The pain may restrict breathing or the ability to walk which increases the risk of pneumonia and blood clots in the legs.
If cancer has damaged a vertebra, kyphoplasty may make the bone a little taller to compensate for the loss of height that occurs with compression. Kyphoplasty may relieve pain as well. Your doctor may perform a biopsy before creating space and injecting the cement-like material.
Kyphoplasty is performed only after other treatments have failed. Conservative treatments include wearing a back brace and/or taking pain medicine.
- Bleeding - Your doctor will provide you with a list of medications to avoid which increase your risk of bleeding. Blood tests may be ordered to assess your risk of bleeding.
- Infection - Performing the procedure in a sterile fashion and ruling out any active infections will lower your risk of infection occurring because of the kyphoplasty.
- Increased back pain - This is unlikely if your doctor confirms that your fracture is new or acute. An MRI, bone scan and physical examination under fluoroscopy will confirm this.
- Nerve damage leading to numbness, tingling or weakness - Your doctor should be experienced and trained in performing the procedure. Using fluoroscopy (x-ray guidance) is required to perform the procedure.
- Allergic reactions - Your doctor should obtain a history of previous allergies to medications, contrast agents, contrast dyes or iodine.
- Cement-like material leaking out of position - Using fluoroscopy (x-ray guidance) throughout the procedure and understanding the anatomy of the spine lowers this risk.
The radiation used during an X-ray procedure is low. However, if you are pregnant kyphoplasty should not be performed.
Other risks may occur which are related to any other medical conditions you may have. Provide your doctor with a detailed list of these conditions before having the procedure performed.
A history and physical examination will be performed by your doctor before the procedure. An X-ray, MRI scan or bone scan may be performed to assist your doctor in identifying the fracture or fractures. Blood tests may also be ordered.
Medications or supplements you are taking may increase your risk of bleeding and should be provided to your doctor. Make your doctor aware of any allergies to any medications, contrast agents, contrast dyes or iodine.
Avoid eating or drinking anything for several hours before the surgery. Someone must drive you to the procedure and home afterward.
An anesthesia provider will put an IV line into a vein to give you an antibiotic and sedating medicine. Some doctors prefer general anesthesia. However, I have never had to perform the procedure with my patient under general anesthesia.
During the Kyphoplasty
You will lay face down on an operating table, and your blood pressure, heart rate, and oxygen saturation will be monitored throughout the procedure.
The doctor will insert a needle through your skin and back muscles and into the bone containing the fracture. He or she will either inflate the balloon or create space with a dilator such as an osteotome. This creates space for the cement-like material and may increase the height of the bone. Your doctor will then inject the cement mixture into the bone and obtain an X-ray image after each injection to ensure that the cement goes to the appropriate location. The needle is removed, and sterile dressings are applied.
The procedure will probably take less than an hour for one vertebra. If more than one vertebra is treated with kyphoplasty, the procedure may take longer. You will spend time in a recovery room after the surgery for approximately three hours, but you will be able to go home the same day.
You may walk an hour after the procedure. Soreness might occur where the needle was put into your back for a few days. Pain relief is usually immediately after the kyphoplasty is completed. Your doctor should provide you with a list of activities to avoid after the procedure.
If you have osteoporosis, certain minerals, vitamins, and medications to help strengthen your bones may lower your incidence of future fractures in your spine. Discuss this with your doctor and primary care physician.
Tania Faruque MD is the medical director of Palomar Spine & Pain, in Escondido, CA (North San Diego County).