Understanding Kyphoplasty

Understanding Kyphoplasty

What Is Kyphoplasty?

Kyphoplasty is a minimally invasive procedure designed to treat vertebral compression fractures (VCFs), which are breaks or cracks in the vertebral bones of the spine. The primary purposes of kyphoplasty are to alleviate the debilitating pain caused by these fractures, restore the height of the collapsed vertebra, correct the deformity known as kyphosis which creates a hunched over posture, and provide a quick return to daily activities.

 

This procedure offers several key benefits, including rapid pain relief, spinal deformity correction, and a relatively quick recovery time. At Desert Spine and Sports Physicians, we strive to help patients overcome pain and functional limitations through advanced nonsurgical procedures such as kyphoplasty.

Vertebral Compression Fractures Explained

 

The human spine consists of a series of vertebral bones or vertebrae stacked on top of one another, creating a strong yet flexible column that protects the spinal cord and nerves. A vertebral compression fracture occurs when the vertebral body, the thick block of bone that forms the front of the vertebra, becomes weakened due to osteoporosis and collapses under the weight and pressure of the body. These fractures can cause significant pain, loss of height, and an abnormal curvature of the spine known as kyphosis, which can lead to breathing difficulties and other complications if left untreated.

Causes and Symptoms of Vertebral Compression Fractures

 

Understanding the Causes

Osteoporosis, a condition characterized by the loss of bone density and weakened bone, is the primary culprit behind vertebral compression fractures. As bones become more porous and fragile due to osteoporosis, even everyday activities such as lifting, bending, or twisting can put excessive stress on the vertebrae, leading to cracks or fractures in the weakened bones.

 

Recognizing the Symptoms

  • Acute, severe back pain: This pain arises suddenly, often after a routine activity or minor falls, and can be severe.
  • Change in posture or hunched-over appearance: A kyphotic deformity, characterized by the spine rounding forward, can result from the collapsed vertebrae.
  • Long-term consequences if left untreated: Issues resulting from vertebral fractures include chronic back pain, difficulty with walking and everyday activities such as lifting, reaching, pushing and pulling, and in some cases – significant respiratory issues.

Kyphoplasty Procedure: What to Expect

 

Preparing for Kyphoplasty

Before a kyphoplasty procedure, patients undergo a thorough medical examination and diagnostic testing such as an MRI scan, to determine the extent and location of the vertebral compression fracture. Imaging is also important to make sure the fracture is acute or new, and not old. Patients will also receive pre-procedure instructions regarding medication adjustments and fasting requirements. 

 

The Kyphoplasty Procedure Step by Step

The kyphoplasty procedure takes about an hour. During this time, the patient is given conscious sedation and a local anesthetic. The procedure is performed under fluoroscopy or x-ray guidance. 

      1. After numbing the skin, a hollow needle is inserted into the vertebra and a small drill is then used to create a channel in the bone.
      2. A specialized balloon is then inserted into the channel and carefully inflated within the vertebra, creating a cavity and restoring the vertebra’s height and shape.
      3. Once the desired height and shape are achieved, the balloon is deflated and removed.
      4. Bone cement is then injected slowly into the cavity, stabilizing the fracture and providing long-lasting support as the cement hardens.

After the Procedure: Recovery and Care

 

Immediately after the kyphoplasty procedure, patients should remain immobile for a short period to allow the bone cement to set fully. Pain relief is often immediate, though some residual discomfort may persist for a few days. Patients will receive specific instructions regarding medication management and appropriate bracing to aid recovery.

 

Most patients can return to normal activities within a few days, although strenuous activities may need to be limited for several weeks. We will schedule regular follow-up appointments to monitor your progress and provide any necessary long-term care recommendations.

Risks and Complications of Kyphoplasty

 

While kyphoplasty is generally considered a safe and minimally invasive procedure, there are potential risks and rare complications that patients should be aware of and should discuss with the doctor. These may include:

  • Infection or bleeding
  • Allergic reaction to the bone cement or other medications used
  • Cement leakage into surrounding areas
  • Nerve or spinal cord damage (rare)

Life Post-Kyphoplasty

 

After the initial recovery period, patients who have undergone kyphoplasty can gradually resume their daily activities and significantly improve their quality of life. However, it is essential to follow the doctor’s recommendations for a gradual return to physical activities and to attend all scheduled follow-up appointments.

 

To prevent future vertebral compression fractures and maintain the benefits of the kyphoplasty procedure, patients may need to receive ongoing treatment for underlying conditions like osteoporosis. This may involve supplements like Calcium and Vitamin D, medication, and lifestyle changes.

Where Can I Get Kyphoplasty?

 

Desert Spine and Sports Physicians in Arizona offers kyphoplasty procedures performed by experienced interventional pain management specialists. With multiple locations across the state, DSSP provides comprehensive and individualized care for patients suffering from vertebral compression fractures as well as other spine and musculoskeletal conditions.

Phoenix Office

3700 N 24th Street, Ste 210.

Phoenix, AZ 85016

Mesa Office

6634 E. Baseline Rd., Suite 101

Mesa, AZ 85206

Scottsdale Office

8670 E Shea Blvd Suite 102

Scottsdale, AZ 85260

Gilbert Office

3615 S Rome St.

Gilbert, AZ 85297

Peoria Office

13128 N 94th Drive, Suite 200

Peoria, AZ 85381

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Understanding Kyphoplasty – PDF



Understanding Kyphoplasty

Kyphoplasty | Compression Fracture | Back Pain Phoenix Mesa Scottsdale

Kyphoplasty

Low back pain is one of the most common reasons patients present to their physician. In fact, up to 84% of adults will experience low back pain at some point in their lives. While for most patients, the episodes are self-limited, there are more concerning causes of back pain requiring immediate attention such as vertebral compression fractures (VCFs). It is reported that up to 50% of women and 25% of men will have a VCF in their lifetime which correlates to approximately 1 to 1.5 million vertebral compression fractures per year in the United States. VCFs are directly correlated with increasing age and incidence of osteoporosis. As our population continues to grow older, these numbers will continue to grow.

Classically, VCFs result from an axial/compressive or flexion load on a weakened/osteoporotic vertebral body. This type of load places a large force on the anterior half of the vertebral body, making it the most common site of injury. Compression here produces the classic wedge-shaped deformity. The resulting kyphotic deformity may alter the biomechanics of the spine, placing strain on other neighboring structures even after the fracture is healed.

Patients with acute VCFs often present with severe pain. While management of pain associated with these fractures is not standardized, common strategies include activity modification, analgesics, and postural bracing. Often, these treatment modalities are sufficient to control the pain. However, if the pain is persistent and uncontrolled, other modalities may be considered to help prevent progression to chronic pain and disability. Chronic pain associated with VCFs is more difficult to manage because the pain is no longer related to the fracture itself but also to the strain on spinal muscles and ligaments secondary to the resulting kyphosis. Patients with moderate to severe pain that is functionally limiting and not responding to more conservative care may benefit from kyphoplasty if they are an appropriate candidate.

What is Kyphoplasty?

Kyphoplasty is a minimally invasive procedure performed under fluoroscopy for the management of acute VCFs (<6 weeks old). In order to determine if this is an appropriate procedure, a physician will first conduct a complete history and examination and then interpret pertinent imaging including MRI or CT. The intervention then typically has 5 main steps:

  1. The patient is positioned prone and then typically given conscious sedation. The skin will then be prepped and draped.
  2. After injecting local anesthetic, the physician uses fluoroscopy to insert a trocar (hollow needle) through the pedicle into the vertebral body. Sometimes a mallet is used to tap in the trocar.
  3. The physician creates a working channel in the vertebrae with a drill and then inserts an inflatable balloon. The balloon is inflated in an attempt to restore vertebral height and reduce kyphosis. The balloon is then deflated and withdrawn leaving an empty cavity within the vertebral body.
  4. Acrylic bone cement is then injected slowly into the vertebrae where it hardens and binds to the bone. This stabilizes the fracture and prevents further collapse.
  5. The trocar is withdrawn, and the site is covered with a bandaid. The patient remains prone until the cement hardens.

How does a Kyphoplasty improve pain?

There are several theories regarding the analgesic effect of kyphoplasty. The first is related to mechanical stabilization of the weakened/fractured vertebral body. In addition, reducing the kyphosis created by the fracture leads to less muscular and ligamentous strain associated with abnormal spine biomechanics. Lastly, the cement undergoes an exothermic (heat-releasing) reaction when it hardens; the ensuing thermal damage to the intraosseous nerve fibers within the vertebral body may also lead to pain relief.

Physicians trained in performing this procedure include Board-Certified Physical Medicine and Rehabilitation specialists including the physicians at Desert Spine and Sports Medicine as well as Anesthesiologists and Interventional Radiologists.

In Conclusion:

Kyphoplasty Treatment in Scottsdale, Phoenix & Mesa AZ

Kyphoplasty is a minimally invasive procedure which may be helpful in treating uncontrolled pain associated with a VCF. It is important to note, that this procedure is not appropriate for all patients. As board-certified specialists in Physical Medicine and Rehabilitation (PM&R), we are experts at evaluating and managing various causes of back pain including VCFs. Here at Desert Spine and Sports Physicians, we take the time to determine the most appropriate, evidence based, non-surgical treatment for each patient. If you have any further questions, feel free to contact us at Desert Spine and Sports Physicians to see if this procedure is right for your patient.

 

Sources

https://www.ncbi.nlm.nih.gov/books/NBK448171/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693826/ 
https://www.cms.gov/medicare-coverage-database/details/technology-assessments-details.aspx?TAId=25&bc=AAAQAAAAAAAAAA%3D%3D&