Kyphoplasty and Vertebroplasty
A spinal fracture occurs when one of the bones in the spinal column breaks. This type of fracture is also known as a vertebral compression fracture because the bone that breaks (the vertebral body) often cracks and collapses, becoming compressed. The vertebral bodies are less dense and more "spongy" than the other bones in your body to accommodate movements like bending and twisting. Because your vertebral bodies aren't as strong as the bones in your legs, they can become more vulnerable to fracture.
Certain diseases, such as osteoporosis or cancer, are known to cause loss of bone mass and changes in bone structure, making them brittle and weak. Genetic factors and certain lifestyles, such as a low calcium diet, can also damage bone. Over time, the vertebral bodies can become so weak that normal activities such as bending over or lifting a bag of groceries, can cause a spinal fracture.
Symptoms of Spinal Fractures
Although you can't feel your bones getting weaker, you might feel a spinal fracture when it occurs. Sudden and severe pain, out of proportion to the activity at hand, is a hallmark sign of a spinal fracture. For most of us, the thought of breaking a bone during normal, non-strenuous activity is difficult to imagine. Many patients mistakenly attribute the pain of a spinal fracture to a muscle strain or "bad back." Further complicating the issue is that spinal fractures often occur with only mild, or even indiscernible, pain.
Symptoms commonly associated with spinal fractures that are caused by osteoporosis or cancer include:
- Sudden onset of back pain, unrelated or out of proportion to activity
- Pain worsens with sitting or standing
- Pain is often relieved by lying down
Treatment of Spinal Fractures
To provide relief of the pain of a vertebral fracture, two types of minimally invasive procedures are available. These procedures, Vertebroplasty and Kyphoplasty, are most commonly used in cases of severe pain caused by a vertebral fracture that does not improve over a number of weeks with pain medication and treatment with a brace. Both vertebroplasty and kyphoplasty procedures involve the placement of cement into the fractured vertebra through small, minimally invasive incisions in the skin under x-ray guidance.
The procedure known as vertebroplasty is generally done with the patient sedated but awake, in an x-ray suite. In vertebroplasty:
- A bone cement is injected under pressure directly into the fractured vertebra.
- Once in position, the cement hardens in about 10 minutes, congealing the fragments of the fractured vertebra and providing immediate stability.
The procedure known as kyphoplasty is commonly done under general anesthesia in an x-ray suite, although kyphoplasty can also be done under a local anesthesia. In kyphoplasty:
- A balloon catheter, similar to the one used in angioplasty of the heart, is guided into the vertebra and inflated with a liquid under pressure.
- As the balloon inflates, it can help to actively restore the collapse in the vertebra due to the fracture and can also correct abnormal wedging of the broken vertebra.
- Once the balloon is maximally inflated, it is deflated and removed, and the large cavity created is filled with bone cement lower pressure than in a vertebroplasty.
- The cement then hardens in place, maintaining any correction of collapse and wedging.
Kyphoplasty can also be very helpful when there is severe collapse of the broken vertebra or wedging, with more collapse in the front of the spine than the back resulting in the spine tending to tilt forward. By correcting the wedging, kyphoplasty may help restore the spine to a more normal alignment and prevent severe kyphotic ("hunchback") deformity to the spine. In someone who has had multiple fractures with previous wedging, kyphoplasty can prevent further worsening of the deformity. Both techniques are successful about 90% of the time in relieving the pain of fractured vertebrae. Kyphoplasty is more helpful in correcting vertebral collapse and wedging if it is done within six weeks of the fracture.
Potential risks and complications
These cement injection procedures are not without significant risks, so the decision to use these procedures is made on a case-by-case basis and should not be taken lightly.
- The most common complication is leakage of cement out of the vertebra with injection and before final hardening.
- If the cement leaks back into the spinal canal it can compress the spinal cord and nerves, causing new pain and neurologic problems.
- There also has been rare case reports of pulmonary embolism of the lungs and even death associated with these procedures.
Overall, these percutaneous vertebral body cement injection procedures represent a new advance and a helpful part of the treatment of vertebral fractures in select cases. With all of this in mind, the patient and doctor must sit down and discuss whether such a procedure is right for the patient.
To schedule with an appointment with a MedStar Harbor Hospital expert interventional radiologist, please call 410-350-3300.
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