Kyphoplasty: How It Works

If you are someone unfortunate enough to suffer from vertebral compression fractures, then you know how painful and debilitating this condition can be. Vertebral compression fractures are collapsed vertebrae, usually in the thoracic or lumbar regions of the spine, and are often caused by osteoporosis. Osteoporosis erodes material from the bony vertebrae, making them susceptible to collapse when pressure is applied.

If untreated, vertebral compression fractures can lead to loss of height or a deformed spine.  Kyphosis, also known as “dowager’s hump”, is the resulting condition in which the shoulders slump forward and the upper back appears enlarged as a hump. 

There are two primary treatment options for vertebral compression fractures: vertebroplasty or kyphoplasty. Both procedures inject bone cement into a collapsed vertebra to help stabilize and strengthen the fractured bones.  A kyphoplasty procedure, however, inserts an inflatable balloon before the cement is added in order to help normalize the height of the vertebra.

As you age, your bones naturally weaken, but for the more than 44 million Americans with low bone mass or osteoporosis, the risk of vertebral compression fractures is high. For the ten million Americans who suffer from osteoporosis, vertebral compression fractures are often a hidden danger. Despite vertebral compression fractures being the most common kind of fracture among osteoporosis patients, more than 750,000 Americans experience VCFs every year. 

Why Do Vertebral Compression Fractures Occur?

Osteoporosis is the most common cause of vertebral compression fractures because it weakens bones. Once spinal vertebrae are sufficiently weakened, even commonplace activities like climbing stairs or sneezing may be violent enough to collapse the bones. VCFs may occur among healthy people as well but a much more powerful trauma like hard fall or car accident is usually involved.

There is also one other cause of vertebral compression fractures that you should know about—cancer. If cancer has spread to the spine, then it will deplete the bone of nutrients and weaken it. That is why if you suspect a vertebral compression fracture has occurred and you have had cancer before, you should seek immediate medical attention.

Symptoms of Vertebral Compression Fractures

There are some distinctive signs of vertebral compression fractures that can alert you if one has happened. You should be especially alert to any of these symptoms if you are over age 50, female or diagnosed with osteoporosis because of your elevated risk.

• Sudden back pain
• Pain when standing or walking complemented by less pain in a prone position
• Reduced spinal mobility
• Diminishing height
• Spinal deformity

It is vitally important that your doctor make an accurate diagnosis if a vertebral compression fracture has occurred. Studies show that women that experience a vertebral compression fracture are 15 percent more likely to have an early death. Unfortunately, only about one-third of patients who encounter a VCF are correctly diagnosed and treated because people often mistake this condition for arthritis.

If your doctor suspects that you have a VCF, then they will conduct a thorough medical evaluation including patient and family medical history. In the past, doctors may have used an x-ray to detect a vertebral compression fracture, but it has been determined that this kind of imagery lacks the granularity to confirm the presence of fractures in the spine. These days, an MRI or CT scan is the preferred diagnostic tool for VCFs. Your doctor may also conduct a bone density test to determine if your bone mass is at a healthy level.

Treatment Options for Vertebral Compression Fractures

Doctors have used many traditional therapies to treat VCFs prior to the development of vertebroplasty and kyphoplasty, including

• Bed rest
• Medications including pain killers, anti-inflammatories and muscle relaxants
• Back braces

Why Kyphoplasty Is a Better Option

In order to limit the risk of additional fractures in the spine as well as other skeletal regions, your doctor may prescribe drugs that strengthen bones like Actonel, Boniva or Fosamax.

More conventional therapies offer limited benefits for patients with a vertebral compression fracture.  These treatment options may eventually alleviate some pain symptoms, but they fail to correct damage that has already occurred.

That is why a surgical remedy is often of greater benefit to VCF patients. Vertebroplasty was invented in the 1990s, and kyphoplasty shortly afterwards.  Both procedures are minimally invasive, meaning that there is only minute scarring and a reduced recovery period. Both procedures enjoy about a 90 percent success rate, i.e. they reduce pain from VCFs.

In the vertebroplasty procedure, a thin needle is inserted into the collapsed vertebra.  A bone cement is then injected into the bone.  After about ten minutes, the cement hardens.  This does stabilize the weakened vertebra, but it does not return it to its previous height, and it does not correct any kyphosis that may have resulted from the fracture.

The kyphoplasty procedure is very similar to the vertebroplasty, but instead of merely injecting the bone cement, a balloon is first inserted into the collapsed vertebra.  The balloon is then filled with a liquid to inflate it. This returns the vertebra to its original height.  The balloon is then removed, and the bone cement is injected.

Kyphoplasty has some significant advantages over vertebroplasty, including

• The kyphoplasty procedure can correct “wedging” in which the front of the vertebra is more collapsed than the front.  This enables the patient to return to a more normal posture, alleviating unnatural strain on bones, muscles and organs.
• Kyphoplasty is more beneficial for patients who have experienced vertebral compression fractures in the past and now suffer from kyphosis because it prevents further spinal deformation.

You should also be aware of some of the risks associated with vertebroplasty and kyphoplasty.

• Sometimes, the bone cement may leak out of the vertebra before it has hardened. This may lead to compression of spinal nerves, pain or other neurological symptoms.
• In rare cases, liquid bone cement has leaked into nearby veins. It may then travel to the lungs and cause a pulmonary embolism resulting in respiratory distress or even death.
• As with any surgery, there is the risk of complications including cardiac arrest or stroke.

Article written by: Dr. Robert Moghim – CEO/Founder Colorado Pain Care

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