Vertebroplasty and Kyphoplasty
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Vertebropasty and Kyphoplasty are two innovative, minimally invasive, non-surgical procedures that have proven to strengthen the vertebrae of your spine and significantly improve pain caused by vertebral body compression fractures. Fractures are often secondary to osteoporosis, cancer metastasis, or trauma. Arizona Pain Specialists is happy to provide these treatments to the Phoenix area. These exciting new therapies have helped people even when conservative therapies have not provided adequate relief (De Negri 2007). The syndromes most commonly requiring Vertebroplasty & Kyphoplasty include:
- Bone cancer metastasis
Vertebroplasty is an outpatient technique that involves injecting acrylic cement with a biopsy needle into the fractured painful vertebra. The needle is placed with x-ray guidance for proper placement. The acrylic cement quickly dries and forms a support structure within the vertebra that provide stabilization and strength. The needle makes a small puncture in your skin that is easily covered with a small bandage after the procedure. For your comfort, patients are given local anesthesia and light sedation for the procedure.
Kyphoplasty is also referred to Balloon Assisted Vertebroplasty. This method involves placing needles into the fractured vertebra and placing a strong inflatable balloon into the vertebra under x-ray. When the balloon is inflated, it makes a space in the center of the vertebrae, where acrylic cement can be injected using low pressure. The technique works very similarly to Vertebroplasty, but the inflation of the balloon may result in an increase in the vertebral body height.
Vertebroplasty is a frequently used ground breaking procedure that has proven to reduce pain, increase vertebral body height, and decrease wedge angle without worsening of the retropulsion of the vertebrae (Hiwatashi 2007). Kyphoplasty has also been shown to restore vertebral height and vertical alignment that was damaged by the collapse of the vertebrae. Patients with compression fractures typically exhibit kyphosis. Kyphosis or “hump back” is curving of the spine due to the collapse of the vertebrae. This can be very debilitating and embarrassing for the person who experiences it. In a 2006 study, Kyphoplasty was shown to enhance height reduction and accounted for over 80% of the height restoration that was lost. Kyphoplasty also showed that 90.7% of fractures improved following procedure (Shindle 2006). If height restoration is considered to be a goal then Kyphoplasty may have some advantages over Vertebroplasty.
As with all medications and surgical procedures, there is always a risk of complications. Kyphoplasty and Vertebroplasty are considered appropriate non-surgical minimally invasive treatments for many patients who suffer from back pain. Some of the associated risks that can be produced are from the leak of acrylic cement outside of the vertebral body. Although severe complications are extremely rare, it is important to know that infection, bleeding, numbness, tingling, headache, and paralysis may ensue due to misplacement of the needle or cement. This particular risk is decreased by the use of x-ray or other radiological imaging to ensure proper placement of the cement. Although there are potential risks, published studies indicate that Kyphoplasty and Vertebroplasty are safe methods of treating painful vertebral compression fractures and complications are rare with these procedures (DaFonseca 2006) (Hiwatashi 2007).
Fracture Prevention: A balanced diet, regular exercise, weight lifting, calcium, vitamin D supplements, and bisphosphonates (like Fosamax) may help prevent additional compression fractures due to Osteoporosis. These treatments strengthen bone and prevent further loss in bone density. If you do suffer a painful compression fractures, you may be good candidates for minimally invasive procedures that have been proven effective, including Vertebroplasty and Kyphoplasty (Old 2004). Vertebroplasty and Kyphoplasty are exhilarating new techniques that provide therapeutic benefit by significantly reducing pain and improving mobility in patients with vertebral fractures. In a 2007 report it was noted that 95% of people treated with these procedures showed partial or complete immediate pain relief (Hiwatashi 2007). The American Society of Interventional Pain Physicians developed a large evidence-based practice guideline for the management of chronic spinal pain with interventional techniques. The article stated that for vertebral augmentation procedures, the evidence of relief and improvement is moderate for both Vertebroplasty and Kyphoplasty. (Boswell 2007). If you are suffering from chronic back pain due to a compression fracture contact Arizona Pain Specialists today to see if you can benefit from these state of the art treatments.
Testimonial from Arizona Pain Specialists patient Dan Foley. Dan suffered a spinal injury in his L1 vertebra due to a Quad Accident. Dr Paul J Lynch talks about the wedge fracture and the vertebroplasty procedure.
Vertebral height restoration in osteoporotic compression fractures: kyphoplasty balloon tamp is superior to postural correction alone. Shindle MK, Gardner MJ, Koob J, Bukata S, Cabin JA, Lane JM. Osteoporosis Int. 2006 Dec;17(12):1815- 9. Epub 2006 Sep 16 PMID: 16983458 [Balloon kyphoplasty in the therapy of vertebral fractures] DaFonseca K, Baier M, Grafe I, Libicher M, Noeldge G, Kasperk C, Meeder PJ. Orthopade. 2006 Oct;35(10):1101-9 PMID: 17195295 Interventional techniques: evidence-based practice guidelines in the management of chronic spinal pain. Boswell MV, Trescot AM, Datta S, Schultz DM, Hansen HC, Abdi S, Sehgal N, Shah RV, Singh V, Benyamin RM, Patel VB, Buenaventura RM, Colson JD, Cordner HJ, Epter RS, Jasper JF, Dunbar EE, Atluri SL, Bowman RC, Deer TR, Swicegood JR, Staats PS, Smith HS, Burton AW, Kloth DS, Giordano J, Manchikanti L; American Society of Interventional Pain Physicians. Pain Physician. 2007 Jan;10(1):7-111 PMID: 17256025 Vertebroplasty for osteoporotic fractures with spinal canal compromise Hiwatashi A, Westesson PL. AJNR Am J Neuroradiol. 2007 Apr;28(4):690-2 PMID: 17416822 Treatment of painful osteoporotic or traumatic vertebral compression fractures by percutaneous vertebral augmentation procedures: a nonrandomized comparison between vertebroplasty and kyphoplasty. De Negri P, Tirri T, Paternoster G, Modano P. Clin J Pain. 2007 Jun;23(5):425-30 PMID: 17515741 Vertebral Compression Fractures in the Elderly. Old, Jerry; Calvert, Michelle. American Family Physician. January 1, 2004