STATEWIDE OSTEOPOROSIS RESOURCE CENTER
 

Other Treatments

 

VERTEBROPLASTY AND KYPHOPLASTY

What is vertebroplasty?

Vertebroplasty is a minimally invasive, non-surgical procedure used to help relieve pain and strengthen a broken spinal bone or vertebra as a result of a compression fracture from osteoporosis. This is a relatively new technique with limited research to measure the effectiveness and safety of this procedure. It is important to discuss all of the potential benefits and risks of having this procedure with a medical doctor.

What are the potential benefits of vertebroplasty?

The benefits of vertebroplasty may include:
• stabilizing a crushed vertebra
• helping to reduce or stop chronic back pain when other methods of pain management have failed to provide relief.
• increasing an individual’s ability to return to his or her previous level of activity

Who should have this procedure?

Pain from a vertebral fracture usually improves within a few days but may take two to six weeks to completely resolve. It is rare for a patient to have persistent pain beyond this period. Vertebroplasty may be considered for some individuals with severe and persistent pain who do not get pain relief from the conventional treatments such as pain relief medications, cold or heat therapy or bed rest. At this point, this relatively new procedure should be limited for use as a last resort for pain management.

When is the best time to have a vertebroplasty?

If patients have severe and persistent pain and do not get pain relief from the conventional treatments such as pain relief medications, cold or heat therapy, or bed rest after approximately several weeks, they may be a candidate for vertebroplasty. In addition, it is recommended that patients have the procedure done within the first 6 months after the onset of pain.

Who performs a vertebroplasty?

A vertebroplasty is performed by a spine orthopedist, a neurosurgeon or an interventional radiologist who is specially trained to perform this procedure.

How is the procedure for verteboplasty done?

Vertebroplasty is performed in a hospital setting. It is usually performed in the morning as a day procedure and generally does not require an overnight stay. (An overnight stay is usually only recommended for a person who is frail, has other medical conditions that may require more monitoring, or lives at home alone and has no one to help.)

  • Throughout the procedure the patient is positioned lying faced down. A sedative medication will be given by intravenous (a needle in the vein) to the individual to relax and minimize any discomfort. In addition, a local anesthetic is used to numb the skin and the muscles near the fracture. Intravenous antibiotics may be used during the procedure in order to prevent infection.
  • Under x-ray guidance a hollow needle is passed through the spinal muscles and positioned in the fractured vertebra. When the doctor determines he or she has reached safely within the fractured bone a medical-grade bone epoxy or glue is injected.
  • The epoxy hardens usually in ten to twenty minutes. After completing the procedure that usually takes about 1 hour per vertebra, the doctor removes the needle and places a dry dressing over the area.

Are there side effects or complications from having a vertebroplasty?

There have been no randomized controlled trials to evaluate the effectiveness and safety of vertebroplasty and most information is based on observation. The data suggests that the procedure is effective at relieving pain in people who have suffered severe and persistent pain. Overall risk is relatively low but some of the risk may include:

  • Local bleeding at puncture site
  • Infection
  • Worsening of pain
  • Neurological Complications suc as weakness or leg pain
  • Possible fracture in the spine or ribs during the procedure
  • Cement leakage around the spinal cord
  • Some of these complications may occur as a result of the actual procedure and some may occur from the risks associated with anesthesia.

How long is the recuperation after a vertebroplasty procedure?

Following vertebroplasty the doctor usually recommends bed rest for the first 24 hours. Some people may feel some soreness at the point where the needle was inserted for the procedure. Usually an icepack helps to relieve this discomfort. Most individuals are able to resume their usual activity within two days after the procedure. It is always important to follow the recommendations from the treating doctor.

What is kyphoplasty?

Kyphoplasty is a minimally invasive surgical procedure used to help relieve pain and strengthen a broken spinal bone or vertebra as a result of a compression fracture from osteoporosis. This is a relatively new technique with limited research to measure the effectiveness and safety of this procedure. It is important to discuss all of the potential benefits and risks of having this procedure with a medical doctor.

What are the potential benefits of kyphoplasty?

The benefits of kyphoplasty may include:
• stabilizing a crushed vertebra
• helping to reduce or stop chronic back pain when other methods of pain management have failed to provide relief.
• restoring height and reducing the deformity of the vertebral body
• increasing an individual’s ability to return to his or her previous level of activity

How is kyphoplasty different than vertebroplasty?

Vertebroplasty and kyphoplasty are very similar procedures. Both help to reduce pain and discomfort from a compression fracture and stabilize the bone. The main difference is that kyphoplasty unlike vertebroplasty may restore the height or shape of a compressed or wedged vertebral body.

Can kyphoplasty help prevent further fracture?

There is no long-term clinical evidence that this procedure will prevent further fracture In fact, there is some concern that by increasing the stiffness in the affected bone, the bone above or below might be subject to abnormal forces that could increase the risk of fracture in an adjacent vertebra.

When is the best time to have kyphoplasty?

If patients have severe and persistent pain and do not get pain relief from the conventional treatments such as pain relief medications, cold or heat therapy, or bed rest after approximately several weeks, they may be a candidate for vertebroplasty. In addition, it is recommended that patients have the procedure done within the first 6 months after the onset of pain.

Who performs a kyphoplasty?

A kyphoplasty procedure is usually performed by a spinal orthopedist, a neurosurgeon or an interventional radiologist who is specially trained to perform this procedure.

Who should consider this procedure?

Pain from a vertebral fracture usually improves within a few days but may take two to six weeks to completely resolve. It is rare for a patient to have persistent pain beyond this period. Kyphoplasty may be considered for some individuals with severe and persistent pain who do not get pain relief from the conventional treatments such as pain relief medications, cold or heat therapy, or bed rest. At this point, this relatively new procedure should be limited for use as a last resort for pain management.

How is kyphoplasty performed?

Kyphoplasty is performed in the hospital setting. It is usually done as a day procedure and generally does not require an over night stay. An overnight stay is usually only recommended for a person who is frail, has other medical conditions that may require more monitoring, or lives at home alone and has no one to help.

• Throughout the procedure the individual will be positioned lying faced down. A sedative medication will be administered by intravenous (a needle in a vein) to relax the patient and minimize any discomfort. In addition, a local anesthetic is used to numb the skin and the muscles near the fracture. Intravenous antibiotics may be used during the procedure in order to prevent infection. Some individuals require or may choose to have general anesthesia.

• A small incision is made into the back. A special instrument known as a fluoroscope helps guide the doctor to place the tube into the fractured or broken vertebra. When the doctor places the tube in position he or she will insert a special balloon that is carefully inflated. As it inflates it helps elevate the fracture. Click here to watch a video of the kyphoplasty procedure.

• The last part of the procedure includes removing the balloon and than placing a special medical cement-like substance into the cavity. This cement -like material dries quickly.

• The procedure takes about one hour per vertebra.

Are there side effects or complications from having a kyphoplasty?

There have been no randomized controlled trials to evaluate the effectiveness and safety of this procedure and most information is based on observation. The data suggests that the procedure is effective at relieving pain in people who have suffered severe and persistent pain. Overall risk is relatively low but some of the risks may include:

• Local bleeding at incision site
• Infection
• Worsening of pain
• Nerve damage or spinal cord injury if the instruments are not positioned correctly into the back
• Nerve injury or spinal cord compression from the cement-like material leaking into the body
• Allergic reaction to the solution used to visualize the balloon

These complications may occur as a result of the actual procedure or some may occur from the risks associated with anesthesia.

How long does it take to recover?

Some individuals experience pain relief almost immediately. Others report relief within two days of the procedure. After discharge from the hospital the doctor usually recommends bed rest for 24 hours and recommends increasing activity as tolerated. However, lifting is not recommended usually for at least 6 weeks or when the doctor gives permission to resume all activities.

How can I protect my bones after vertebroplasty or kyphoplasty?

An individual that has vertebroplasty or kyphoplasty must still continue to make bone healthy lifestyle choice. The treatment of osteoporosis should always include a varied, nutrient-rich diet, adequate intake of calcium and vitamin D, regular physical activity, safety precautions for fall prevention, avoidance of smoking and limited consumption of alcohol. Following vertebroplasty or kyphoplasty, your healthcare provider will advise you to continue (or start) an osteoporosis medication to help stop further bone loss and to reduce your risk for broken bones.