Vertebroplasty/Kyphoplasty

What They Are

Vertebroplasty and kyphoplasty are surgical procedures that involve injecting cement into a fractured vertebra in order to stabilize the broken bone and relieve pain. Such fractures most commonly occur as a result of bone weakening from osteoporosis and can result in severe, persistent pain and disability.

While both are methods of vertebral augmentation with only a slight difference in how they are done, the procedures share common goals: To improve symptoms and quality of life.

What Are Vertebroplasty and Kyphoplasty?

Vertebroplasty and kyphoplasty are minimally invasive surgical procedures performed under sedation or general anesthesia in an outpatient facility.

Both vertebroplasty and kyphoplasty involve the injection of a type of cement called polymethylmethacrylate (PMMA) into fractured bone in the spinal column.

While the terms are often used interchangeably, kyphoplasty is really a subtype of vertebroplasty. It is distinguished by the fact that it involves an additional step of inserting and inflating a balloon before the cement injection.
Denaro V, Longo UG, Maffulli N, Denaro L. Vertebroplasty and kyphoplasty. Clin Cases Miner Bone Metab. 2009 May-Aug; 6(2): 125–130.

This creates a cavity that can lower the amount of pressure required to inject the cement.

Image guidance is used during vertebroplasty and kyphoplasty; this is accomplished with fluoroscopy or computed tomography (CT) scan. Image guidance helps guide the surgeon as they operate.

Kyphoplasty is generally performed more often than vertebroplasty and is associated with a lower complication rate.3 Nevertheless, research does not suggest that one procedure is more effective in terms of reducing pain and disability than the other.

These scheduled procedures are almost always performed on adults; rarely, they may be performed on a child. Most patients go home the same day after either procedure.

Contraindications

Absolute contraindications to vertebroplasty or kyphoplasty include:6

Asymptomatic vertebral fracture or fracture that improves with medical measures (e.g., rest and pain medication)
An uncontrolled bleeding disorder
An allergy to bone cement
A tumor that involves the spinal canal
Local (vertebral body) or a generalized infection

Additional contraindications include back pain unrelated to a vertebral fracture, such as a disc herniation or spinal stenosis. Imaging tests, like a magnetic resonance imaging (MRI) of the spine, can help healthcare providers confirm a diagnosis.

Potential Risks

Vertebroplasty and kyphoplasty are generally considered safe, low-risk procedures. However, in some instances, serious complications may occur.

These complications include:

Infection
Bleeding
Cement (PMMA) leaking, which may result in pain, tingling, numbness, or weakness (more common for vertebroplasty than kyphoplasty)

Rare complications include:

Pulmonary embolism from cement particles traveling to the lung
Spinal stenosis from cement leaking into the epidural space
Nerve root or spinal cord damage resulting in paralysis (extremely rare)

Purpose of Vertebroplasty and Kyphoplasty

The purpose of vertebroplasty and kyphoplasty is to alleviate pain and improve disability in patients with vertebral fractures.8 Kyphoplasty can also help restore some or all of the height of the bone and, therefore, improve spine alignment.

Most commonly, these procedures are used to treat compression fractures that result from osteoporosis. Less commonly, the procedures are used to treat fractures that result from cancer, trauma, or osteonecrosis.

While vertebroplasty and kyphoplasty are considered safe, they are not without risk. In addition, the data regarding the efficacy of these procedures is still evolving and conflicting.

As a result, vertebroplasty/kyphoplasty is generally only indicated in patients with a vertebral fracture who, despite undergoing conservative medical measures, continue to experience severe and disabling back pain.

Failed medical therapy may be defined as patients who:

Continue to have pain despite undergoing medical therapy for a minimum of six weeks
Have back pain that prevents them from walking or engaging in physical therapy (even when taking pain medication)
Experience significant side effects from their pain medication (e.g, confusion or severe constipation)

How to Prepare

If you have decided to undergo vertebroplasty or kyphoplasty, your healthcare provider will provide various pre-operative instructions.

These instructions may include:

Stop taking certain prescription or over-the-counter medications for a period of time before the procedure—for example, nonsteroidal anti-inflammatory medications (NSAIDs) or blood thinners.
Arrange to have someone drive you home after the surgery.

What to Expect on the Day of Surgery

With both vertebroplasty and kyphoplasty, bone cement is injected into the fractured vertebrae. Kyphoplasty also includes creating a cavity with a special balloon.

For vertebroplasty or kyphoplasty, you can expect the following steps to occur after you are prepared for surgery and anesthesia has been delivered:

The surgeon will make a small incision (cut) over the area of the fractured vertebrae.
Using X-ray guidance, the surgeon will insert a special instrument called a trocar (a needle surrounded by a narrow tube) into one side of the fractured vertebrae.
If kyphoplasty is being performed, a special balloon will be inserted through the trocar and inflated to create an open cavity inside the bone. Once the new cavity is created, the balloon is deflated and removed.
For both vertebroplasty and kyphoplasty, the surgeon will inject the bone cement into the cavity and close the incision site.
You will continue to lie on the operating table until the cement hardens (this takes a few minutes).

After the procedure, which lasts less than an hour, you will be taken to a recovery room. Once the anesthesia or sedative has worn off, most patients are able to go home.

Recovery

Before you leave the surgical center, your healthcare provider will provide you with various instructions to follow at home, such as:

Applying ice to your back (as needed) for any soreness related to the procedure
Returning to normal activities (usually right away) and avoiding strenuous activities for a period of time (usually six weeks)
Following up with your healthcare provider for osteoporosis management, if that was the cause of your fracture

Some patients experience immediate pain relief after vertebroplasty or kyphoplasty. For others, pain relief usually occurs within a few days of the procedure. Cleveland Clinic. Kyphoplasty/Vertebroplasty. Reviewed December 2016.

Long-Term Care

Vertebral fractures are common, especially in postmenopausal women, in whom osteoporosis is also common. Due to the potentially severe, disabling pain associated with these fractures, it’s sensible to take steps to prevent another from occurring.

Prevention of osteoporosis-related vertebral fractures entails engaging in various non-pharmacologic therapies, including:

Performing daily weight-bearing exercises
Ensuring adequate calcium intake and vitamin D supplementation
Stopping smoking
Moderating alcohol intake
Addressing strategies to prevent falls (e.g., avoiding high-risk medications, correcting vision problems, etc.)

In cases where osteoporosis caused the fracture, initiating medication that treats the osteoporosis is indicated.