Kyphoplasty

Kyphoplasty is a surgical procedure used to treat painful compression fractures in the spine. Such fractures are usually caused by osteoporosis. Due to these fractures, the spinal column may collapse resulting in a forward rounding of the back, also referred to as kyphosis. Kyphoplasty also corrects this hunching posture and restores some of the lost vertebral height.

The following are the indications for kyphoplasty:

• Compression fractures not later than eight weeks prior to surgery
• The patient is experiencing painful symptoms and spinal deformities
• Less invasive treatment measures such as bed rest, and back brace have been ineffective
• Elderly patients or weak who would have impaired healing from a fracture
• Malignant tumour causing the compression fracture
• Osteoporosis arising from metabolic disorder or long-term use of steroid treatments

Some of the contraindications of kyphoplasty are as follows:

• Where bones are weak due to cancer
• The collapse of the spinal column due to osteoporosis
• Problems in the spine due to a herniated disk, back arthritis
• Curve in the spine due to scoliosis
• For patients with a healed vertebral fracture
• Patients having any lung condition preventing them from lying face down

Kyphoplasty is only used for repairing recent compression fractures. It is not a preventive treatment and cannot correct an established deformity of the spine. It is not usually advised for otherwise healthy young patients, because younger people heal faster than elderly ones or those suffering from osteoporosis. The doctor would also review the shape of the fracture because certain types such as crush fractures or biconcave fractures are less likely to have positive outcomes from this surgery.

Before the procedure, the doctor (orthopaedic) carries out a physical examination. Blood tests may also be carried out. Additionally, an X-ray and MRI of the spine may be carried out to locate the fractures.

The doctors would also discuss recent illnesses and any allergies to anaesthesia or contrast materials. The ongoing medications are also reviewed. Any medications such as NSAIDs or anticoagulants that may increase the risk of increased complications during the surgery are temporarily stopped.

Alcohol, smoking and tobacco use are advised to be reduced, as these lessen the chance of bone healing.

The patient is required to fast six hours before the surgery – no foods or drinks are permitted. A small amount of water may be allowed but only up to three hours prior to surgery. Since this surgery involves anaesthesia, the patient is advised to arrange for a ride home. Prior to surgery, the doctor may also provide medications to help avoid pain and nausea and also give antibiotics to prevent infection.

Before the surgery, the patient changes into a hospital gown. Thereafter, the patient is taken into the operating room where they lie in the supine position (on their back) on the operating table. To keep track of vitals, the patient is attached to a monitor.  An IV cannula is attached that administers medication during the surgery

Fluoroscopy is used for X-ray guidance while performing the surgery. A hollow needle (called trocar) is inserted into the skin and passing through the back muscles is guided to the fractured area of the bone. Thereafter, a special balloon (bone tamp) is inserted through the trocar and into the vertebra.

Once in position, the balloon will be gently inflated to create space for a hole or cavity inside the vertebra, thus returning it to its natural height. The balloon is then deflated and removed.

After this, using a specially designed instrument, the cavity that is created is slowly filled with polymethylmethacrylate, which appears like toothpaste and is a cement-like material, also referred to as bone cement. This material hardens typically within 20 minutes.

After the material is injected, the trocar is removed and no stitches are needed. Pressure is put to stop any bleeding and the opening in the skin is covered with a bandage.

The entire procedure usually takes up to one hour. However, if there is more than one vertebra, it may take more time.

Some of the risks and complications arising from kyphoplasty include:

• Infection
• Bleeding
• Allergic reactions to chemicals used with X-rays or to bone cement
• Leakage of bone cement: at times, the bone cement might move beyond the compression cavity for which it was intended. This rarely causes any complications.
• Paralysis: this might occur in case the spinal cord or any nerve gets damaged.
• Increased back pain: In some cases, kyphoplasty is not effective in treating pain, such as when the bone cement leaks onto the spinal cord or nerve root, which could lead to the worsening of the pain.
• Tingling, numbness or weakness because of nerve damage
• Pulmonary embolism: In case bone cement gets into a vertebral vein, there is a chance that it may travel to the lung and block an artery.

Kyphoplasty may increase the risk of compression fractures at other spinal levels.

After the surgery, an X-ray or a CT scan might be performed to evaluate the distribution of the bone cement.

The patient will be required to spend about an hour in the recovery room, though it may extend to 24 hours. After an hour, the patient is asked to walk. The patient may require an overnight stay.

In many cases, the relief from pain is noticeable just after the surgery.

There is likely to be soreness in the back where the trocar was inserted. However, this resolves in a few days.

Discharge instructions typically include:

• The bandage is to not be removed for 48 hours and not to be submerged in water during this time. However, showers can be taken.
• Applying ice packs for 15 minutes per hour to reduce pain and soreness
• No strenuous activities for at least six weeks.
• No driving for a few days to a few weeks, without confirmation from the doctor
• Taking multivitamins and other medications for bone strengthening and preventing fractures

A follow-up visit may be required for a physical check-up, radiological tests and blood tests.

Kyphoplasty is a minimally-invasive surgical procedure used in elderly patients or those suffering from osteoporosis to correct the spinal column for recent compression fractures. The procedure is considered quite safe and is generally successful in improving pain. The patients are quickly able to gain mobility and be more active. Kyphoplasty also helps regain lost height due to hunched back. Complications are rare. Complete recovery can take six weeks, depending on the health status of the patient.