Kyphoplasty: Procedure & benefits

Kyphoplasty for back pain

What is kyphoplasty?

Kyphoplasty is a procedure to treat vertebral compression fractures, which are generally caused by osteoporosis. When a vertebra fractures, the resulting bone fragments undergo sliding motion, generating friction and potential harm to the spinal canal, nerve roots, or spinal cord. This detrimental process gives rise to experiences of pain, weakness, and in severe cases, limb paralysis. Kyphoplasty represents an effective treatment modality for addressing this particular lesion, as it rectifies the issue by restoring the volume of the vertebral body and filling it with a cement-like substance.

In this approach, the surgeon inserts a hollow needle called a trocar through the skin into the vertebral body using image guidance (fluoroscopy). Subsequently, the fracture location is extended via a balloon and then a mixture of cement is injected into the osseous tissue. After that, the fracture site is expanded using a balloon and then cement mixture is injected into the bone. This leads:

  • restoration of the vertebra height
  • improvement the alignment of the spine
  • reduction of the abnormal force applied to the vertebrae
  • reduction of the risk of fracture in the future
  • relieving the pain

Treatment methods for spinal compression fractures

Vertebral fractures constitute the most prevalent fractures induced by osteoporosis. In addition to back pain, spinal compression fractures can engender spinal deformity and diminished mobility. Some of the prescribed modalities for managing these fractures encompass bed rest, physical therapy, and the utilization of braces. However, in some situations, non-surgical interventions may prove insufficient in mitigating the patient’s pain, necessitating surgical intervention. Among the approaches to minimally invasive spine surgery, kyphoplasty emerges as a notable method.

How is kyphoplasty performed?

Step 1: Patient preparation

A wide range of diagnostic tests such as blood tests, imaging (X-ray, CT and MRI) and bone densitometry scans may be performed to confirm the presence of a vertebral fracture and check other physical conditions of the individual before surgical intervention. On the day of the procedure, depending on the location of the spine (cervical, thoracic or lumbar) where the compressed vertebra is located, the patient’s back or neck is disinfected and prepared. Subsequently, the patient lies on upon the operating table, and a regional anesthetic is introduced.

Step 2: Trocar entry

The trocar enters the patient’s vertebral body. The surgeon employs fluoroscopy to adjust the precise positioning of the trocar. To prevent contact with the spinal cord, the trocar is inclined and introduced into the vertebral body through rotational movements or with assistance from a hammer.

Step 3: Restoring the height of the bead using a balloon

In the next step, the surgeon inserts the balloon into the vertebral body via the trocar. To insert the balloon, the surgeon initially employs a drill to establish a pathway. Subsequently, the surgeon carefully inflates the balloon, thereby restoring the vertebra to its normal height. Following this, the balloon is deflated and pulled out, resulting in the creation of a sufficient area of free space for cement injection and facilitating the bone’s return to its normal size and shape.

Step 4: Injection of bone cement

At this particular stage, bone cement is slowly injected into the vertebral body. The pressure and the quantity of the infused cement are carefully controlled by the surgeon to effectively avert its undesired leaking. Concurrently, X-ray imaging is employed to ascertain the precise placement of the cement.

Step 5: The final step

Finally, the trocars are removed before the hardening of the cement. Due to the minuscule of the incision, the suturation is unnecessary for this particular procedure. To seal the incision site, it is possible to utilize dressing and skin tapes.

Top players in kyphoplasty set market

  • Johnson & Johnson
  • Joimax GmbH
  • Teknimed
  • Globus Medical
  • Stryker Corporation

Asia Jarah Pishro Company offers kyphoplasty tool sets in three models to medical centers:

What is the difference between kyphoplasty and vertebroplasty?

Both kyphoplasty and vertebroplasty are effective treatment options for repairing and alleviating pain resulting from compression fractures of the vertebrae; however, they possess dissimilarities. Vertebroplasty entails the injection of bone cement through the skin into the spongy bone of the vertebral body with the intent of mitigating pain, averting further decrement in vertebral height, and preventing damage to the spinal cord. The kyphoplasty technique employs the utilization of a balloon to rectify the fracture and modify the configuration of the vertebra, assuage pain stemming from spinal fractures, stabilize the skeletal structure, reinstate the diminished vertebra height, and diminish the degree of kyphosis. In both methodologies, the employment of visual guidance, typically fluoroscopy, is indispensable.

Some biomechanical studies have revealed that kyphoplasty demonstrates superior advantages over vertebroplasty in terms of augmenting and reinstating the height of the vertebral body and ameliorating kyphosis.  Additionally, owing to the utilization of a balloon and the subsequent creation of ample space, the probability of cement leakage is diminished in this particular technique. It is worth noting that patients subjected to each of these methodologies experience substantial alleviation of pain and the incidence of complications is minimal for both approaches. Consequently, it can be surmised that both kyphoplasty and vertebroplasty are secure and efficacious modalities for the management of compression fractures affecting the vertebral body.

What is bone cement and what materials is it made of?

Bone cements are biomaterials obtained by mixing the powder phase and liquid phase. These cements possess the ability to be shaped and introduced into the body in the form of a paste. Using cement, it becomes possible to fill bone cracks or gaps that may occur between the implant and the bone. The injectability of these cements has greatly broadened their application as a minimally invasive surgical technique, thereby establishing their widespread utilization in a variety of orthopedic applications.

Several options are available for the utilization of materials as cements or fillers. For many years, the orthopedic field has employed the polymer known as polymethyl methacrylate (PMMA) as the primary choice for cement. This biocompatible material possesses favorable mechanical characteristics and can be easily identified via X-ray analysis. Consequently, it serves as a highly suitable selection as a primary ingredient for bone cement. Viable substitutes for PMMA, possessing comparable biomechanical attributes, include calcium sulfate and calcium phosphate.

Advantages of kyphoplasty

  • Filling the pores that are formed due to osteoporosis, thus thereby augmenting bone integrity and diminishing the likelihood of re-fracture.
  • Restoring the height of the vertebrae body
  • Pain relief and improved mobility usually within 48 hours after surgery
  • Just a few weeks after surgery, two-thirds of patients are capable of substantially diminishing their analgesic dosage.

Possible risks of using the kyphoplasty technique

Kyphoplasty is a safe and effective surgical procedure, but like any surgical intervention, it can be associated with possible complications, the most important of which are mentioned below:

  • infection
  • Bleeding
  • Problems caused by anesthesia
  • Continued back pain
  • Tingling, numbness, or weakness due to nerve or spinal cord injury
  • Allergic reactions to chemicals used for x-ray imaging
  • Leakage of cement into surrounding tissues that can lead to compression of nerve elements or venous embolism.

Depending on the individual’s physical state, it is noteworthy that the patient may encounter additional hazards. For example, if a patient is afflicted with osteoporosis, there arises a possibility of experiencing additional fractures in the various vertebrae of the spinal column. To avert this undesirable outcome, medical practitioners prescribe the administration of pharmaceuticals aimed at enhancing the quality of bone tissue to the patient.

Use cases of kyphoplasty

Kyphoplasty is commonly advised for individuals who experience persistent lumbar pain and limited mobility due to compression fractures resulting from osteoporosis or pathological factors such as bone marrow cancer, metastatic cancer, or benign vascular tumors. Additionally, this technique is employed in cases where the patient is advanced in age and physically debilitated to the extent that open or reconstructive surgeries of the vertebrae are not a viable option.

Generally, kyphoplasty is utilized in situations where conventional treatments such as rest, the use of medical braces, physiotherapy, and analgesic medications have proven ineffective. Naturally, conditions such as bone infections, spinal canal tumors, bleeding disorders, and drug sensitivities render the patient unsuitable for this therapeutic intervention.

Why was this procedure called kyphoplasty?

This method is called kyphoplasty; Because it mitigates undesirable kyphosis or anterior curving of the spine.

The best time to do this

The optimal timing for this procedure is immediately after the occurrence of a fracture. The performance of this procedure should take place within a time frame of 8 weeks from the initial fracture to maximize the potential for recuperation.

Is kyphoplasty painful?

The patient may experience sensations of discomfort in the region where the trocar is inserted. It is important to note that such discomfort is expected to subside within a matter of days.

How long does kyphoplasty take?

The duration of the kyphoplasty procedure typically ranges from 20 minutes to an hour. Patients commonly report alleviated pain levels and improved mobility within a period of 1 to 3 days following the surgical operation.

How long does the patient stay in the hospital after kyphoplasty?

Patients undergoing kyphoplasty are typically discharged either on the same day of the operation or the subsequent morning.

Does the patient need to take special medications after kyphoplasty?

The patient may be prescribed certain vitamins and medications to enhance the fortitude of the skeletal structure and avert any further instances of fractures within the spinal region.

Is it necessary for the patient to utilize a brace??

The determination regarding the necessity of employing a brace after the kyphoplasty procedure will be made by the attending physician.

When can the patient resume exercise?

Patients are typically advised to commence walking as soon as possible, often within an hour of the conclusion of the procedure. It is advisable to consult with one’s surgeon regarding any activities that should be avoided. Generally, it is recommended to avoid heavy exercise for 4 to 6 weeks after surgery.

Does the patient need rehabilitation or physiotherapy?

Physiotherapy is not necessary after kyphoplasty.

Will the patient have long-term limitations after kyphoplasty?

There are no long-term restrictions following kyphoplasty.

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