Vertebroplasty vs. Kyphoplasty: Which is the Best?

By January 12, 2023January 25th, 2023Treatment

Vertebroplasty vs. Kyphoplasty: Which is the Best? - PMIRRegarding spinal surgeries, vertebroplasty vs. kyphoplasty are some of the most debated and least invasive procedures. Both procedures are similar and serve a related purpose: to stabilize an unstable spinal joint, usually after a vertebral compression fracture (VCF) or spinal compression fracture (SCF). These procedures are both known as vertebral augmentation surgeries.

The spine comprises a column of stacked bones, with special discs between each bone. In combination, the discs and bones make the spine mobile and resistant to shock and shear forces to a certain degree. This allows us to bend over, jump, and even fall without significant injury.

But a chain is only as strong as its weakest link, and in many cases, this weak link is the integrity and bone density of the most stressed spinal joints or vertebrae. Conditions like osteoporosis can take a toll on the body’s bone density, as can a sedentary lifestyle. Weaker bones are easier to crack, and certain vertebrae – especially those in the lower back and neck – may need to endure more significant strain over time than most. After a certain point, even a light sneeze or picking your luggage up off the floor can result in a fracture.

Understanding Vertebroplasty vs. Kyphoplasty

Among individuals with stronger or healthier bones, compression fractures are usually the result of sudden and violent trauma, like a fall from a great height or a car accident. The whiplash of a car crash or the direct impact of falling down a flight of stairs can crack the vertebra.

A cracked vertebra loses its integrity, which can cause the spine to shift. Imagine a building, and imagine if half of the load-bearing walls or pillars on one floor suddenly caved in. Gravity would cause the rest of the building to sag and lean to one side, if not collapse. In humans, a severe vertebral fracture can cause spinal deformation (such as severe kyphosis or a hunched back), nerve impingement, and chronic pain in much the same way.

Both vertebroplasty and vertebroplasty address spinal fractures by using special biocompatible bone cement to fill in the cracks in an unstable vertebra and prevent further instability and damage. One is used to minimize the risk of a collapsed vertebra. The other is used to reverse spinal deformation caused by a vertebral compression fracture potentially.

Vertebroplasty vs. Kyphoplasty: How They Are Performed? 

Both vertebroplasty and kyphoplasty are minimally invasive procedures with the same general preparation – both usually require x-ray imaging and utilize local anesthesia. The patient is often awake but may elect to be sedated.

Other medications are used to keep a patient calm instead because of the risk of general anesthesia. It isn’t needed to perform minimally invasive vertebroplasty and kyphoplasty. In both cases, a patient lies on their stomach (face down) while a specialist uses a needle to inject a dye into the back and an x-ray machine to highlight the area around the affected joint.

Vertebroplasty

In the case of vertebroplasty, once the affected joint is visible, the doctor guides a needle into the affected joint and mixes a fluid bone cement using a special liquid and powder combination. The resulting fluid is slowly pumped into the affected joint, filling the cracks and hardening the bone. At this point, the two conditions diverge. As a result, the cracked vertebra fuses again, and the risk of spinal instability is alleviated.  

Kyphoplasty

In the case of kyphoplasty, the target vertebra has already collapsed and yet remains unstable. This means that the bone has given way under pressure but could still pose a danger to the surrounding nerves and is causing significant pain.

To help correct the wedging, a balloon is inserted through the needle first. This is similar to the type of balloon used in heart surgeries. The balloon is inflated with liquid, pushing apart the fractured bone and creating a small cavity within the vertebra. During this process, because the patient is prone, the pressure from the balloon should help correct the wedging and improve the spine’s integrity.

Once the cavity is created, the balloon is slowly deflated by removing the liquid and the balloon itself. Another needle is used to insert a thicker bone cement than in vertebroplasty, but this time, it fills the newly formed cavity within the bone.

In vertebroplasty vs kyphoplasty, the patient is kept in the clinic for a few hours to ensure that the cement hardens appropriately and to minimize the risk of post-surgical complications. While there is no need for an incision or general anesthesia, there are still a few risks, including spinal nerve compression, leakage, bleeding, or infection. Observing a resting patient can minimize these early risks and help ensure success.

When Is Surgery Necessary?

As a general rule, a doctor will not recommend vertebral augmentation surgery if the patient’s condition is stable, meaning their spine is not in danger of shifting, and their symptoms have passed. To consider vertebroplasty or kyphoplasty, a patient must have attempted to address their pain and fracture through more conservative treatments, such as a back brace, medication, physical therapy, and ample rest, to no avail.

There are specific contraindications for surgery or conditions that would make surgery inadvisable. These include blood clotting disorders or the use of blood-thinning medication. Depending on the condition and dosage, your doctor may still allow surgery if you stop taking your medication for a short period before the procedure. A recent infection will also rule out surgery until more time has passed.

Do I Need a Vertebroplasty or a Kyphoplasty? 

When it comes to your spine health, time is of the essence. If your doctor recommends a kyphoplasty or a similar procedure, understanding how it is performed and your prognosis after treatment can help you offset the worry that comes with spinal surgery.

If your doctor suspects a compression fracture, stay calm. While surgical intervention is on the table for some instances, it’s important to remember that a fracture in and of itself does not always require stabilization.

Many compression fractures are inherently stable, and any symptoms of pain or loss of mobility can be solved through careful pain management, mobilization, and physical therapy. Yes, even a compression fracture in the spine can and often will heal “on its own” with a proper treatment course involving supportive exercises and equipment to minimize the risk of further injury and improve quality of life.

However, while nonsurgical interventions can go a long way towards managing pain symptoms and even improving mobility and quality of life through patient-specific therapies and physical conditioning, there are circumstances where the stability of the spine is compromised to the point that surgical intervention becomes necessary to minimize the risk of paralysis, or further damage to the spine. Unstable compression fractures along the vertebrae are a typical example of such circumstances.

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