Spinal surgeries typically come into play whenever a patient presents with an illness, disease, or injury with a significant risk of deterioration, and complications including partial paralysis (or worse). They may also be a necessary tool in cases where no level of pain management can replace the relief experienced through a surgical procedure that might remove the physical culprit of the pain. In the case of kyphoplasty procedure, the condition usually in question is a vertebral compression fracture (VCF), and the procedure aims to stabilize a compromised vertebra (spinal bone) through the use of a tiny balloon and the subsequent injection of specialized bone cement (vertebroplasty). This is a minimally invasive augmentation surgery and is performed entirely with needles and x-rays as guidance. While that sounds scary, the kyphoplasty procedure is a safe surgical solution for an otherwise hazardous condition. The spine is a crucial physical pillar of the human body and remains core to our nervous system. A crushed vertebra needs to be addressed immediately.
How Does the Kyphoplasty Procedure Work?
A little lesson in medical nomenclature can help us understand the term better: kyphos, from the Greek, means hunch and is also used in kyphosis, a spine deformation where the back rounds excessively. The -plasty suffix means the surgery is augmentative, meaning it isn’t planning to excise tissue but alter it. Put together. Kyphoplasty procedure involves augmenting bone in the hunch of the back (in this case with a small balloon), usually because the condition causing it (a VCF) results in a collapsed or hunched spine and a loss of height.
The same goes for vertebroplasty, usually the second half of the procedure (the bone cement), and augments a vertebra through an injection of a special acrylic paste. This is to prevent the bone from collapsing in on itself again. Patients don’t need to be opened up for a kyphoplasty procedure. Most of the work is done through needles, and patients generally don’t even need to be under general anesthesia. Local anesthesia may be enough. As with most surgeries, patients need to observe a few basic rules before going under the needle. These include:
- No anti-coagulating (blood thinners) medication a few days before the procedure, including drugs like aspirin and warfarin.
- No food at least several hours before the procedure.
- Sips of water are fine.
- Consult your doctor regarding any other medication you need to take to ensure that none of your meds might interfere with the anesthesia or the procedure.
- Inform them of everything you’ve taken.
The procedure itself can be summarized in about three steps. These are:
- The patient will undress and either go under or have a local anesthetic applied via injection.
- The doctor will begin the procedure by guiding a needle through to the spine with an x-ray machine.
- Then, the needle will be used to pass a small balloon into the fractured bone. The balloon is inflated.
That’s it. Usually, bone cement is injected into the gap left by the balloon to stabilize it. As the term implies, bone cement is a self-setting material stored as a powder and liquid components, mixed into a paste, and hardens after injection. Bone cements are biomaterials, which means they can be injected into the body without the risk of the body rejecting the material. They are also used in knee, hip, and other joint surgeries and fillers for dental cavities. They’re usually polymer-based or made out of plastic. Coincidentally, the same plastic as Plexiglas. Bone cements can also be made out of calcium phosphate.
Understanding Vertebral Compression Fractures (VCF)
The vertebroplasty and kyphoplasty procedure are utilized almost exclusively to treat dangerous and painful vertebral fractures, specifically vertebral compression fractures. Most of these are caused by osteoporosis or bone-weakening diseases like cancer. As such, most cases of VCF occur in older women, although vertebral fractures can occur at any point in life and to any gender. A vertebral compression fracture is identified when a spinal bone loses at least some height, which can be tested via imaging, including CT scans, x-ray, myelograms, MRIs, and other imaging techniques.
Patients with back pain and osteoporosis, cancer, loss of mobility, or a previous VCF should visit a doctor as soon as possible. Not all cases of VCF need to be treated via kyphoplasty procedure. In fact, some of them shouldn’t. Kyphoplasty procedure also isn’t used as a preventative measure to support a fractured but otherwise stable bone or to strengthen the spine in an otherwise healthy person with no symptoms of pain or lack of mobility. Despite sharing the same prefix, it also isn’t used to treat most other causes of kyphosis, including hereditary or idiopathic structural kyphosis. Signs that you might need a kyphoplasty procedure after a fractured vertebra include:
- Unmediated pain for more than two weeks, no response to alternative pain management options.
- Advancing cancer or benign growths in the surrounding area.
- Spinal osteonecrosis (decaying bone due to lack of blood supply in the area).
- As a temporary solution before a larger stabilization procedure (spinal fusion).
Kyphoplasty Procedure Risks and Recovery Time
Patients generally shouldn’t be considered candidates for kyphoplasty procedure if their vertebra is considered stable, if their fracture has otherwise healed, if it’s been present for more than one year without continued pain or complications, if the bone in question has collapsed by more than 80 percent, or if the pain and loss of function are associated with other spinal conditions (such as spinal stenosis or a herniated disc). Infections, inflammation, and blood clotting issues in the area usually also count as contraindicative to surgery.
In cases where the kyphoplasty procedure is the recommended course of action, there are still risks. No procedure is 100 percent safe, and patients should always be aware of what might happen. Complications from the procedure, including minor ones, arise in about 2 percent of compression fractures and 10 percent of cancer-related compression fractures. The risks associated with kyphoplasty include:
- Infection at the injection site.
- Leaking bone cement (if it hasn’t been set properly).
- More back pain (due to spinal cord or nerve compression).
- An allergy to the chemical used in the myelogram (a special dye).
Listen carefully to your doctor’s instructions to minimize the risk of these complications. Recovery time for the procedure is speedy. Soreness at the injection site might last a few days. Your doctor will give you a more specific recovery period based on your age and condition. Still, you can generally go back to your day-to-day life following the procedure, with only a few limitations within the recovery period (such as not lifting heavy things for a little while or avoiding rigorous activity) or no restrictions at all.