Kyphoplasty

Kyphoplasty is a minimally invasive procedure designed to stabilize acute and subacute compression fractures of the thoracic and lumbar spine. In order for this procedure to be effective, a fracture must still be painful, must still be in the process of healing, and must have the characteristics of a compression fracture. The type of fracture is most easily seen on a plain x-ray, although MRI or CT are occasionally necessary to determine if bone has been pushed back into the nerve space (Burst fracture). MRI is used whenever possible to determine the age or acuity of the fracture. Kyphoplasty can successfully treat compression fractures associated with trauma, osteoporosis, myeloma, metastatic cancer, and benign tumors as long as there is a remaining shell of bone to contain the cement and no significant tumor or bone fragments within the nerve canals (vertebral canal or foramen). As long as swelling remains in the bone, it is treatable with this technique.

Kyphoplasty was developed by Kyphon, Inc. in the later half of the 1990s, as a "minimal intervention option" for elderly patients that could not withstand a major procedure. It can be done under local or general anesthesia, and in many instances as an outpatient procedure. The process is rather simple:

1) The broken vertebrae is visualized on the C-arm fluoroscope (or preferably two C-arms).

2) Small tubes are placed down through the pedicles of the fractured vertebrae on each side.

3) Balloons are inserted and inflated, restoring the height of the vertebrae, pushing soft cancellous bone outward, sealing the cracks in the fracture, and creating a space within the bone to place bone cement.

4) The balloons are deflated and removed.

5) Bone cement is injected in a very thick dough like state into the cavity within the fractured bone, reinforcing it and stabilizing the fracture.

Documented outcomes with this procedure include: improvement in the level of pain from 8.5 to 2.5 over the first week  (1-10 scale), great improvement in ability to ambulate, function and perform activities of daily living in greater than 90% of patients. Complication rates associated with cement injury in less than 0.3%.

It differs from a similar option called vertebroplasty in that:

1) Vertebroplasty does not use balloons to create a void, therefore there is no fracture reduction and the deformity is frozen in place whereas kyphoplasty will typically correct about 50% of the deformity and malalignment depending upon fracture age.

2) In Vertebroplasty the cement must be inserted in a more liquid form, increasing the chances for cement leakage which can cause pressure on nerve roots or spread of cement into the circulation or lungs.. Without the balloons the procedure is considerably less expensive.

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                                                    Last modified: 04/04/06