Kyphoplasty and the Treatment of Spinal Compression Fractures

Kyphoplasty is a minimally invasive surgical procedure that treats your spine’s vertebral compression fractures. These are wedge-shaped fractures that can be extremely painful, and both injuries and osteoporosis can cause them. If you leave them and don’t treat them, they can lead to a condition called kyphosis. By injecting cement into your spine into these fractured areas after you use a balloon to restore your vertebra’s height, you can reduce the risk of having more fractures in the future while healing quicker.

Defining Kyphoplasty

If you have a vertebral compression fracture, your body will collapse in on itself. It typically collapses more in the front than it does in the back, and this creates a wedge-shaped vertebra. If you have several vertebrae that fracture and take on this shape, you can end up with a humped spine. People who have their bones weakened by multiple myeloma or osteoporosis are at a higher risk for these fractures. Things such as sneezing, lifting heavy objects, and coughing can cause your vertebrae to fracture. In turn, this can lead to depression, reduced physical activity levels, back pain, decreased lung capacity, loss of independence, and trouble sleeping.

Kyphoplasty gets performed using a hollow needle that your surgeon will pass through the skin in your back and right into any vertebrae that have fractures. The surgeon will insert a balloon first into the fractured area and inflate it to push the now compressed bone back to the original height. Then, they fill the space with a type of cement. The surgeon will repeat this process for each fracture. You’ll end up with cement-strengthened bones that reduce your pain levels, help you stand up straight, and prevent fractures from happening again.

If you don’t seek treatment, the fractures will start to heal in this collapsed, wedge-shaped position. The benefit of this type of surgical procedure is that the surgeon will push your vertebra into the normal position before the bone heals and hardens. In turn, this can lead to reduced pain levels.

Good Candidates for Kyphoplasty

This surgical procedure could be a viable treatment option if you have compression fractures in your spine from:

  • Benign vascular tumor (vertebral hemangioma)
  • Bone marrow cancer (Multiple myeloma)
  • Cancer spread from another area (Metastatic tumor)
  • Depletion of the calcium levels in your bones (osteoporosis)

If you have the following conditions, you may not be a good candidate for this surgical procedure:

  • Allergies to necessary medications needed during the surgery
  • Bleeding disorders
  • Bone infections (osteomyelitis)
  • Fragment, fracture, or tumor in your spinal canal
  • Non-painful compression fractures that are stable

It’s important to note that this surgery won’t improve chronic or new fractures, and it also won’t work to reduce your back pain if it’s associated with stooping forward and poor posture. Traditional treatment methods involved waiting between four and six weeks to see if your symptoms improved by themselves, but now medical professionals believe that this wait time allows the bones to harden. Many surgeons now suggest you have this surgery within a week of the fracture.

Kyphoplasty Surgical Procedure

Generally speaking, there are five steps involved in this surgical procedure. You can expect the surgery to take around an hour per vertebra the surgeon has to treat.

Step One – Preparation

The surgical team will have you lie on the operating table and give you conscious sedation. Once the medications take effect, they’ll position you on your stomach and support your sides and chest using pillows. Depending on which section the fractures are in, they will cleanse and prep your neck or back. You can have compression fractures in the lumbar, cervical, or thoracic region of your spine.

Step Two – Needle Insertion

The surgeon will inject a local anesthetic before making a very small incision that is around half of an inch long right over the fractured bone. They’ll use a special x-ray machine called a fluoroscope to guide two large-diameter needles into your vertebral body. The needles will go through the pedicles. This fluoroscope lets the surgeon see right where they’re positioning the needles and how far they inserted them. They advance the needles through the bone using a tapping mallet or a twisting motion, and they angle the needles to avoid the spinal cord. Depending on which vertebra has the fracture, they may only need to use a single needle.

Step Three – Restore Your Vertebra Height

If your vertebra has a strong wedge shape, the surgeon will have to insert a balloon through the needles and into your fractured vertebra. They’ll use a grill to create a working channel to insert the balloon tamps into this space. Then, they’ll carefully inflate this balloon to bring the damaged vertebrae back to their original height. The amount of height that they can restore depends on how old the fracture is. Once they finish, they’ll deflate the balloon and take it out, and this leaves space in the middle of your vertebrae. This surgery gets the name kyphoplasty because it works to reduce a forward curvature, or kyphosis, of the bone before they stabilize it.

Step Four – Bone Cement Injection

The surgeon will slowly inject bone cement under pressure to fill in the deepest portion of the fracture first. They’ll then withdraw the needle slightly to fill in the top areas of the fracture. The amount of cement injected and the pressure used is monitored closely to avoid it leaking into unwanted areas. It’s a good idea to completely fill the vertebral body with this cement, but it’s not always necessary or possible to achieve pain relief.

Step Five – Closure

The surgeon then withdraws the needles quickly before the cement starts to harden. They’ll close the small incision area with steri-strips or skin glue. They won’t move you from your position until the cement in the mixing bowl gets hard because this is an indication that the cement in your spine is hard too.

Contact Florida Spine Associates

If you’d like to know more about the kyphoplasty procedure, contact us at Florida Spine Associates. We’re happy to set up a consultation and see if this procedure can improve your quality of life.