What is kyphoplasty method?

Kyphoplasty is a treatment method for vertebral compression fractures that are typically caused by osteoporosis. When a vertebra fractures, the resulting bone fragments can compress, displace, and potentially damage the spinal canal, nerve roots, or spinal cord, causing pain, weakness, or even paralysis. Kyphoplasty is one treatment method that aims to resolve this issue by restoring the vertebral body’s height and filling the space with cement.

In this procedure, the surgeon uses imaging guidance (fluoroscopy) to insert a hollow needle called a trocar through the skin into the vertebral body. Afterward, a balloon is inflated within the fractured area, followed by the injection of a cement mixture into the vertebra. This process achieves the following:

Restores the height of the vertebra.
Improves the alignment of the spinal column.
Reduces the abnormal stress imposed on the vertebrae.
Decreases the risk of future fractures.
Provides pain relief.

Treatment methods for vertebral compression fractures

Vertebral compression fractures are the most common fractures resulting from osteoporosis. In addition to causing back pain, these fractures can lead to a change in the shape of the spinal column and limited mobility.

Some of the approved treatment methods for these fractures include bed rest, physiotherapy, and bracing. However, in certain cases, non-surgical interventions may not suffice to alleviate the patient’s pain, and surgery might be required. One of the minimally invasive surgical procedures for the spine is kyphoplasty.

How kyphoplasty is performed?

Step 1: Patient Preparation

Before the surgery, patients typically undergo diagnostic tests such as blood work, imaging (X-ray, CT, or MRI), and bone density scans to confirm the presence of a vertebral fracture and assess other health conditions. On the day of the procedure, the patient’s back or neck, depending on the location of the fractured vertebra, is cleaned and prepared. The patient lies on an operating table and receives a local anesthetic.

Step 2: Trocar Insertion

Using a fluoroscope (X-ray imaging), the surgeon inserts the trocar into the fractured vertebral body. To prevent spinal cord contact, the trocar is inserted at an angle or using a gentle tapping motion.

Step 3: Vertebral Height Restoration with a Balloon

A balloon is introduced through the trocar to restore the height of the fractured vertebra. First, a special instrument creates a path for the balloon. The surgeon carefully inflates the balloon, returning the vertebra to its natural height. Once complete, the balloon is deflated and removed, creating a void to be filled with bone cement.

Step 4: Bone Cement Injection

Bone cement is slowly injected into the vertebral body. The surgeon closely monitors the pressure and amount of cement, ensuring proper distribution using X-ray images.

Step 5: Final Stage

Before the cement hardens, the trocars are removed. Since the incision is tiny, no sutures may be required. Adhesive skin strips or steri-strips might be used to close the incision site.

Leading kyphoplasty instrument set brands

Johnson & Johnson (Depuy Synthes)
Joimax GmbH
Teknimed
Globus Medical
Stryker Corporation

Asia Jarah Pishro: Kyphoplasty instrument set manufacturer

Asia Jatah Pishro Co., a prominent producer of disposable operating room products, offers three types of kyphoplasty instrument sets:

A complete instrument set includes a Trocar, guide pin, introducer, awl, and cement injection filler, available either individually or as a complete set. However, fast sets only consist of Trocar 4.1 (instead of Trocar 3.1 and introducer), awl, and cement injection filler.

The use of fast sets simplifies procedures, allowing surgeons to operate more swiftly by eliminating the need for guide pins and introducers.

Differences between vertebroplasty and kyphoplasty method

Both kyphoplasty and vertebroplasty serve as effective therapeutic solutions for the treatment of spinal fractures caused by conditions such as osteoporosis. However, key distinctions exist between the two procedures.

In vertebroplasty, bone cement is injected into the vertebral body via a percutaneous approach, aiming to alleviate pain, and prevent spinal deformity. Conversely, kyphoplasty employs a balloon to rectify fractures and modify vertebral shape, targeting the alleviation of pain stemming from spinal fractures, stabilization of bone, and partial or complete restoration of lost vertebral height.

Research in biomechanics suggests that kyphoplasty outperforms vertebroplasty when it comes to increasing vertebral body height, restoring it, and reducing kyphosis. The use of a balloon and the creation of ample space contribute to a lower risk of cement leakage in this procedure. Notably, patients undergoing either of these treatments experience considerable pain relief, and both methods have a low rate of complications. Consequently, both kyphoplasty and vertebroplasty are safe and effective approaches for addressing vertebral compression fractures.

What is bone cement and what is it made of?

Bone cement, a biocompatible material, is created from a combination of powder and liquid phases. This cement can be molded and applied to the body in a dough-like form. Bone cement is used to fill gaps or cavities between implants and bone.

Several materials can be used as cement or filler, with polymethyl methacrylate (PMMA) being the most common choice for bone cement. PMMA has been employed in orthopedic treatments for decades due to its biocompatibility, suitable mechanical properties, and X-ray visibility. These attributes make it an excellent primary bone cement material.

Alternatives to PMMA include calcium sulfate and calcium phosphate cements, which share similar biomechanical properties.

Advantages of kyphoplasty method

Addressing fractures caused by osteoporosis, leading to increased bone strength and reduced risk of refracture
Restoration of vertebral body height
Pain relief and improved mobility typically within 48 hours after surgery
A few weeks post-surgery, two-thirds of patients can significantly decrease their pain medication dosage.

Potential risks of kyphoplasty method

Kyphoplasty is a safe and effective surgical procedure but, like any other surgery, may come with potential side effects, some of which are listed below:

Infection
Bleeding
Complications from anesthesia
Continuous back pain
Numbness, insensitivity, or weakness due to nerve or spinal cord injury
Allergic reactions to the contrast dye used in X-ray imaging
Cement leakage into surrounding tissues, potentially leading to nerve or spinal cord compression

Who is a candidate for kyphoplasty method?

Kyphoplasty is typically recommended for individuals who suffer from compression fractures and debilitating back pain due to conditions such as osteoporosis, metastatic cancer, or benign spinal tumors.

It is also used in cases where patients are too elderly or frail to tolerate open surgery. The primary indication for kyphoplasty is pain related to vertebral fractures that have not responded to conservative treatments like bed rest, orthopedic braces, physical therapy, and pain medications.

However, certain conditions, such as spinal infection, spinal canal tumors, bleeding disorders, and sensitivity to drugs used during surgery, may make a patient unsuitable for this treatment.

Why is this method called kyphoplasty?

This method is called kyphoplasty; because it reduces unwanted or excessive kyphosis.

Which specialist performs kyphoplasty?

Kyphoplasty can be generally performed by neurosurgeons, orthopedic surgeons, or interventional radiologists.

What is the optimal time to perform this procedure?

Kyphoplasty yields the best results when it is performed shortly after a fracture occurs. It should ideally be performed within 8 weeks of a fracture for the highest chance of recovery.

Is kyphoplasty method painful?

Patients may experience pain in the area where the trocar was inserted. This pain should subside within a few days.

How long does the kyphoplasty operation take?

The kyphoplasty operation lasts between 20 minutes to an hour. Patients generally experience improved pain and mobility after 1-3 days.

How long will the patient stay in the hospital post-kyphoplasty?

Patients are usually discharged on the day of the operation or the following morning.

Does the patient require specific medications after kyphoplasty?

Patients may be prescribed vitamins and medication to assist with strengthening the bone and preventing additional fractures in the vertebra.

Will the patient need a brace after kyphoplasty?

The physician will determine whether a brace is required post-kyphoplasty.

When can the patient resume sports activities after kyphoplasty?

Consult with your surgeon on any specific activities to avoid. Strenuous exercises should typically be avoided for 4-6 weeks post-operation.

Will there be any long-term restrictions following kyphoplasty?

There are no long-term restrictions associated with kyphoplasty.

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Kyphoplasty method (Procedure, Advantages, and risks)