Kyphoplasty and Vertebroplasty for
Osteoporotic Thoracolumbar Spine Fractures
If spine pain becomes severe enough to interfere with daily activities or is accompanied by swelling, tenderness, or redness, it’s crucial to seek medical attention.
At Complete Orthopedics, our expert spine specialists are adept at treating spine pain with both surgical and non-surgical approaches. We assess symptoms, pinpoint the issue, and recommend appropriate treatments, including surgery when necessary.
Serving New York City and Long Island, we collaborate with six hospitals to provide cutting-edge spine surgery and comprehensive orthopedic care. Appointments with our orthopedic surgeons can be booked online or by phone.
Discover the common causes of spine pain and explore the available treatment options, including when surgery might be the best choice.
Overview
Osteoporotic vertebral fractures are a major concern, affecting over 100 million people worldwide. These fractures can cause pain and a deformity in the spine called kyphosis.
Kyphosis can negatively impact lung function, bowel movements, and overall quality of life, leading to a decrease in life expectancy. Recent data shows that these spinal deformities can also increase mortality rates.
Non-operative methods of treatment have been inconsistent, leading to the development of surgical methods like vertebroplasty and kyphoplasty. Vertebroplasty involves injecting cement into the fractured vertebra to relieve pain, while kyphoplasty uses balloon tamps to decrease the risk of leakage and correct the deformity.
Surgical Techniques
When performing vertebroplasty, patients are put under general anesthesia and positioned face down with rolls of sheets under the thorax and hips to cause lordosis.
- Trocars are then inserted through the pedicles of the lumbar spine or between the ribs and transverse processes of the thoracic spine.
- Cement is then injected into the anterior vertebral body under fluoroscopic guidance. The injection is stopped when cement fills the area sufficiently or when it starts leaking outside the vertebral body.
Kyphoplasty, like vertebroplasty, is done under general anesthesia with patients lying face down. No particular position for the supports was specified.
- Trocars are inserted through the pedicles at the lumbar spine and between the ribs and transverse processes at the thoracic spine.
- A Kyphoplasty device and introducer system are then used to place two balloons within the vertebral body, which are then filled with saline containing injectable contrast material. Balloon filling and fracture reduction are monitored by lateral fluoroscopy.
- After balloon removal, the cavity is filled with cement to stabilize the reduction.
Before cement injection, a manual check of viscosity is performed in both techniques, which takes place four minutes after the mixing process starts. The quantity of cement employed is documented. If feasible without discomfort, patients can sit up early and begin ambulation on the first day. No braces are required.
Follow-Up
Literature has shown various data to assess the effectiveness of a procedure for treating vertebral fractures. Baseline data included pain intensity, time to management, and deformity in the sagittal plane. Perioperative data such as volume of cement injected and hospital stay is also recorded. After the procedure, patients undergo physical evaluations and radiographs to measure wedge and kyphosis angles, as well as cement filling and leakage.
Patients are seen again 3 months later for further evaluation and to compute reductions in wedge and kyphosis angles. Loss of reduction is also calculated by comparing postoperative measurements with those taken at 3 months. These measurements help assess the success of the procedure.
Results
Follow-up is shorter in the vertebroplasty group than in the kyphoplasty group, and more patients are lost to follow-up in the vertebroplasty group. Literature hasn’t found any significant differences in pain intensity, satisfactory filling, cement leakage rate, or hospital stay length between the two groups. However, operative time is twice as long in the kyphoplasty group, and the volume injected was greater.
Both vertebroplasty and kyphoplasty show significant postoperative improvements in wedge angle (WA), but the kyphoplasty group showed a greater improvement. Additionally, there were no instances of systemic complications related to the cement used in the procedures, no neurological complications, and no new fractures in the treated or adjacent vertebrae.
Although the literature shows significant variability, the results confirm that kyphoplasty effectively relieves pain and reduces deformities caused by osteoporotic vertebral fractures. Vertebroplasty, on the other hand, remains a useful option when performed early, as it is faster and less expensive.
There is no difference in the incidence of clinically detectable complications, and cement diffusion into the cancellous bone is better with vertebroplasty than with kyphoplasty. Additionally, Magerl A1 fractures are more challenging to reduce with both techniques, even in patients with osteoporosis.
If you are interested in knowing more about Kyphoplasty and Vertebroplasty for Osteoporotic Thoracolumbar Spine Fractures you have come to the right place!
Do you have more questions?
What is the main difference between kyphoplasty and vertebroplasty?
Kyphoplasty involves inflating a balloon within the fractured vertebra before injecting bone cement, which can help restore height and reduce spinal deformity. Vertebroplasty involves directly injecting bone cement without using a balloon.
How do these procedures relieve pain from vertebral fractures?
Both procedures stabilize the fractured vertebra, preventing further collapse and reducing movement at the fracture site, which alleviates pain.
Are these procedures suitable for all patients with vertebral fractures?
They are generally suitable for patients with severe pain from osteoporotic vertebral fractures that do not respond to conservative treatments. However, individual suitability must be assessed by a physician.
How long does the pain relief last after kyphoplasty or vertebroplasty?
Pain relief is usually immediate or occurs within a few days after the procedure. Long-term pain relief varies but many patients experience sustained relief.
What are the risks of cement leakage during these procedures?
Cement leakage is a potential risk that can lead to complications if the cement enters the spinal canal or blood vessels. Kyphoplasty generally has a lower risk of leakage compared to vertebroplasty due to the controlled cavity created by the balloon.
Can these procedures restore lost height in the vertebra?
Kyphoplasty can potentially restore some of the lost vertebral height, whereas vertebroplasty primarily focuses on stabilization without significant height restoration.
What is the recovery time after kyphoplasty or vertebroplasty?
Most patients can resume normal activities within a few days. However, heavy lifting and strenuous activities should be avoided for a few weeks.
What kind of anesthesia is used during these procedures?
Both procedures are typically performed under local anesthesia with sedation. General anesthesia is rarely needed.
How effective are these procedures in preventing future fractures?
While they stabilize the treated vertebra, they do not prevent future fractures. Continued osteoporosis treatment is necessary to reduce the risk of additional fractures.
Are there any contraindications for kyphoplasty or vertebroplasty?
Contraindications include active infection, uncorrectable coagulopathy, and certain types of fracture morphology. A thorough medical evaluation is required to identify these contraindications.
What is the typical duration of the procedure?
Both procedures typically take about 1 to 2 hours, depending on the number of vertebrae being treated.
Can these procedures be repeated if necessary?
Yes, if new fractures occur, kyphoplasty or vertebroplasty can be repeated, provided there are no contraindications.
What imaging techniques are used to guide these procedures?
Fluoroscopy or CT imaging is used to guide needle placement and monitor cement injection during the procedures.
How common are adjacent vertebral fractures after these procedures?
There is an increased risk of adjacent vertebral fractures due to altered spinal mechanics. This risk underscores the importance of ongoing osteoporosis management.
What post-procedure care is necessary?
Patients should avoid strenuous activities for a short period, follow a rehabilitation program if recommended, and continue osteoporosis treatment with medications and lifestyle modifications.
How soon can a patient return to normal activities after the procedure?
Most patients can resume normal daily activities within a few days, but heavy lifting and high-impact activities should be avoided for several weeks.
How do these procedures compare to conservative treatments in terms of effectiveness?
Kyphoplasty and vertebroplasty provide faster pain relief and functional recovery compared to conservative treatments like bed rest, pain medication, and physical therapy, which may take weeks to months for similar relief.
What are the long-term outcomes of kyphoplasty and vertebroplasty?
Long-term outcomes are generally positive with significant pain relief and improved mobility, but continuous osteoporosis treatment is essential to maintain these benefits and prevent further fractures.
Can these procedures be performed on multiple vertebrae at the same time?
Yes, multiple vertebrae can be treated in one session if necessary, although the procedure time will be longer.
What is the cost of kyphoplasty and vertebroplasty, and are they covered by insurance?
Costs vary depending on location and specific healthcare provider. These procedures are often covered by insurance if medically indicated.
Are there any alternative treatments to kyphoplasty and vertebroplasty for vertebral compression fractures?
Alternatives include conservative management (rest, pain medication, physical therapy) and other surgical options like spinal fusion in severe cases. The choice depends on the patient’s condition and response to initial treatments.
What advancements in kyphoplasty and vertebroplasty have improved their safety and efficacy?
Advances include better imaging techniques, refined cement formulations, and improved balloon and needle designs, which have enhanced the precision and safety of these procedures.
How do physicians determine which patients are ideal candidates for these procedures?
Ideal candidates are those with severe pain from osteoporotic fractures unresponsive to conservative treatment, without contraindications such as infection or uncorrectable bleeding disorders.
What is the role of physical therapy after kyphoplasty or vertebroplasty?
Physical therapy can help improve mobility, strengthen the back muscles, and enhance overall recovery, contributing to long-term spinal health and function.
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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