Kyphoplasty

A kyphoplasty is a minimally-invasive procedure that involves the use of a balloon to restore the vertebral body height and shape and is followed by the injection of bone cement to strengthen it. This procedure is used to strengthen broken vertebra and to restore the vertebral body height, shape caused mainly by osteoporosis and cancer. This procedure is most commonly used for patients who have not shown improvements with pain medication and braces. This procedure can increase a patient's physical activity and prevent future vertebral fractures. Most patients feel pain relief immediately

Kyphoplasty Goals :-

• Restore height and shape of vertebral body
• Decreasing pain
• Strengthening spine/ prevent further collapse
• Improving mobility

Indications :-

• Stabilization of painful or progressive osteoporotic & osteolytic VCF in thoracic & lumbar spine
• Kummel disease ( AVN of V. body)

Contraindications :-

• Fractures which result in
• significant neurological compromise
• burst components with significant retropulsion of bone into the spinal canal
• involve Post. V. body wall
• morphology restricting V. body access
• Spine infections
• Coagulopathies
• Allergies against PMMA or contrast media
• Solid metastases
• T1–T5 # if unable to visualize on X-ray

Advantage :-

• Early intervention may reduce duration of acute pain, duration of immobilisation use of analgesic, further collapse of v. body, respiratory complications
• pain relief : quick and marked, mobility within 24 hrs

BEFORE THE PROCEDURE

Prior to scheduling the procedure, we will need to evaluate an MRI, bone scan, or CT scan of your spine showing the fracture. At that time you will be sent for an anesthesia consult and pre-procedure testing. Once scheduled for the procedure, you will be contacted by one of the spine nurses. You will be asked to provide information regarding you current problem, past medical history, and medications. She will provide you with detailed instructions on how to prepare for the upcoming procedure. You will be asked to hold any NSAIDS, Aspirin, or blood thinners such as Coumadin.

THE DAY OF PROCEDURE

Prior to arrival we ask that you refrain from eating or drinking after midnight the night before. Please bring your pain medications with you. We do not dispense or provide prescriptions for medications after the procedure. You will need someone to drive you home. Patients without a driver will be rescheduled for another day.

Procedure :-

• During kyphoplasty surgery, a small incision is made in the back through which the doctor places a narrow tube. Using fluoroscopy to guide it to the correct position, the tube creates a path through the back into the fractured area through the pedicle of the involved vertebrae.
• Using X-ray images, the doctor inserts a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position. It also compacts the soft inner bone to create a cavity inside the vertebrae.
• The balloon is removed and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (PMMA). After being injected, the pasty material hardens quickly, stabilizing the bone.

Kyphoplasty surgery to treat a fracture from osteoporosis is performed at a hospital under local or general anesthesia.

Return to normal activity following kyphoplasty

Patients are instructed to resume activity slowly during the next few days and refrain from driving for 24 hours. They are also instructed to look for bleeding or signs of infection, such as redness, swelling, or drainage from the injection site, and to treat any post-procedure back pain as they had done so previously. Patients are then contacted at intervals of one-day, one-week, and one-month to assess progress.

Complication :-

Technique related

• Leakage
• Pneumo / Haemo thorax
• Haematoma
• Neurodeficit

Non Technical

• Early- Anaphylaxis, Embolism
• Delayed – Adjacent level fracture