Vertebroplasty and kyphoplasty are the treatment methods which are used for treating the condition of vertebral compression fracture or VCF. It is a minimal invasive procedure in which vertebral bodies are used to make up the spinal column.

Whenever a vertebral body is fractured, the natural rectangular shape of the bone is compressed which causes pain. Such compression fracture collapses one or more vertebrae in the spine and results in a common condition of osteoporosis. Osteoporosis is the condition in which normal bone density, strength and mass is lost which makes the bones porous and susceptible to breaking. Vertebrae can also be weakened by the condition of cancer.

In the process of vertebraplasty, image guidance is used by the physicians, for injecting a cement mixture into the fractured bone through a hollow needle. In the process of kyphohplasty, a balloon is first inserted into the fractured bone through a hollow needle to create a space or a cavity. The cement is injected into the space or cavity. The cement is injected once the balloon is removed.

Common Uses of Procedures:

The process of kyphoplasty and vertebroplasty are used to treat fractures which are painful and are caused due to vertebral compression in the spine and mostly result in the condition of osteoporosis.

Usually, the process of vertebroplasty is carried out after less invasive treatments like a back brace, back rest or pain medication. This process is not very effective once the medication begins and causes side effects like stomach ulcers or changes in status of mind. On the other hand, vertebroplasty is performed immediately after the patient suffering from problematic pain is hospitalized or is undergoing bed rest and taking pain medications.
Vertebroplasty is also carried out on the following patients:

• Patients who are very old or fragile to bear open spinal surgery or who have very weak bones which make the surgical repair difficult
• Patients who suffer from vertebral compression due to malignant tumor
• Patients who are younger and suffer from osteoporosis due to long-term steroid treatment or a metabolic disorder
• Vertebroplasty and kyphoplasty is carried out within eight weeks of the acute fracture for the highest possibility of the successful treatment.

Tips to Prepare for Vertebroplasty and Kyphoplasty: Some of the tips which can be prepared for vertebroplasty and kyphoplasty are:

• Take in the medicines which are helpful for strengthening your bones.

• Make sure that all the medications you take including the herbal supplements are in the knowledge of the doctor. Your physician will advise you to stop taking non-steroidal anti-inflammatory drugs (NSAIDS) or blood thinners, aspirin for some time before the procedure is carried out.

• Female patients must inform if they are pregnant, to the x-ray technologist. Once the information is communicated, x-ray technologist will use minimum radiation to prevent the fetus from radiation exposure.

• The blood tests must be carried out earlier to confirm that blood clots are normal.

• On the day when procedure has to be carried out the medications must be taken as usual with small amount of water or some clear liquid at least three hours before the actual procedure is carried out. Intake of milk, cream or orange juice must be avoided.

• In case you are taking other medicines like that of blood pressure then they can also be taken with sips of water in the morning itself. While those medicines which are to be taken after eating or drinking anything must be taken several hours before the procedure.

Physical Structure of the Equipment:

The equipment which carry out the procedure of the vertebroplasty and kyphoplasty is a x-ray equipment which has a hollow needle or tube known as orthopedic cement, trocar and a solvent is used. Along with this barium or another substance is added to cement to make it radiopaque.

Balloon tamp is the device which is used for the process of kyphoplasty. This device makes the room for the balloon catheter.

The equipment is basically used to carry out the examination consisting of a radiographic table, television-like monitor, an x-ray tube which is located in the examining room. Fluoroscopy is the procedure which transforms x-rays into video images and is used to watch and guide the progress of the procedure. The video is produced by x-ray machine and an image intensifier is suspended over a table where the patient lies.

Polymethylmethacrylate (PMMA) is the ingredient which is used in orthopedic cement. It is very much similar to toothpaste in physical appearance. The other equipment which is used in the procedure is an intravenous line (IV) and equipment that monitors blood pressure and heart beat. A foley catheter is placed in the bladder.

Procedure of Vertebroplasty and Kyphoplasty:

In the procedure of vertebroplasty involves injection of cement mixture in the empty spaces present in between the weak vertebrae. This helps in strengthening the weak vertebrae and gives relief from the pain. The image-guidance is used to insert a hollow needle called a trocar which is passed through the skin into the vertebral body. This needle injects the mixture of cement into the vertebrae.

In the process of kyphoplasty, a balloon is inserted with the help of trocar inside the fractured vertebra. Once it reaches its destination, it is inflated to create a cavity for the injection of cement. The balloon is removed before the cement is injected into the cavity which was created by the balloon.

Steps Involved in the Procedure:

• The procedure of vertebroplasty and kyphoplasty is generally carried out by specially trained neuroradiologist or interventional radiologist in a neuroradiology suite or interventional radiology or rarely in the operating room.

• The procedure is mostly carried out on outpatients and admission of the patient is carried out only in rare cases.
• The patient undergoing the procedure is positioned on the table with his/her face down.
• The instrument which monitors blood pressure, heart rate and pulse during the procedure is attached to his body.

• The technologist inserts an intravenous (IV) line into a vein present in the arm. This helps in in giving sedative medication intravenously.

• The procedure is carried out under the influence of general anesthesia.
• Medications are given to prevent pain and nausea and antibiotics are given to prevent infection.
• The part from where trocar or hollow needle will be inserted is shaved, sterilized and covered with the help of a surgical drape.
• Local anasthesia is injected into the muscles under the skin near the fracture.
• A small incision is made in the skin at the site.

• Now, with the help of the x-ray guidance, trocar is passed through the muscles of the spine till the time it reaches the tip and positioned itself properly inside the fractured vertebra. An examination called intraosseous venography is carried out to confirm the safe placement inside the fractured bone.

• In the process of vertebroplasty , the orthopedic cement is injected directly. The cement of medical-grade hardens quickly and usually takes 20 minutes.

• In kyphoplasty, the stuff balloon is inserted first using a needle and the balloon is inflated to create a hole or cavity. Later the balloon is removed and bone cement is injected into the hole or cavity created by the balloon.
• The distribution of the cement can be check at the end of the procedure by carrying out the X-rays or a CT scan.
• Removal of trocar is carried out after the cement is injected.
• Pressure is applied to prevent any kind of bleeding and the opening in the skin is covered with the help of a bandage. Sutures are not required here.

• The procedure is generally carried out within a span of one hour and it could even take a longer time in case more than one vertebral body level is to be treated. Later the intravenous line will be removed.

Risks and Benefits Associated with the Procedure of Vertebroplasty and Kyphoplasty:

The benefits associated with the procedure are:

• It increases the functional ability of the patient and allows the affected part to return back to its previous level of activity without any physical therapy or rehabilitation. It also stabilizes the vertebra.

• Both these procedures are very much successful in reducing pain which is caused due to vertebral compression fracture and many patients feel that the procedure provides immediate and significant relief.

• Most of the patients have regained the lost mobility and become active and are also capable of combating osteoporosis, once the procedure is successfully carried out. The patients who were immobile for so long can get out of bed now and also reduces the risk of pneumonia. The increase in activity builds up more muscle strength which in turn increases the mobility.

• Generally the procedures of vertebroplasty and kyphoplasty are effective and safe procedures. The best part of these procedures is that they do not require any incision and only a small hole is made which does not require any stitching after the procedure is completed as it heals on its own.

The risks associated with the process are:

• There are chances of infection as the skin is penetrated for the insertion of the needle and any kind of penetration could invite infection.

• There are chances for the leakage of the orthopedic cement out of the vertebral body. Although it is not a much severe problem till the time the leakage moves into extremely dangerous areas like the spinal canal.

• Some other complications associated with the procedures are bleeding, increase in the back pain, infection, neurological symptoms like tingling and numbness. In rare cases paralysis can also take place.

• Sometimes allergic reactions can also take place.

Limitations of Vertebroplasty:The process of vertebroplasty cannot be used for:

• Arthritis back pain or herniated disks

• The procedure is carried on only on young and healthy patients as the durability of the cement in the vertebral body tends to stay for less time only

• It is a preventive treatment which helps patients suffering from osteoporosis and avoids any further fractures. This procedure is capable of treating only the known, non-healing compression fracture.

• The procedure is helpful in correcting that curvature of spine which is caused due to the presence of osteoporosis; it may be helpful in preventing the curvature from worsening.

Kyphoplasty cannot be carried on patients:

• Having healthy and young bones or those who suffered a fracture in an accident
• Suffering from conditions like scoliosis or kyphosis which are caused due to the presence of osteoporosis
• Suffering from the condition of herniated disk or spinal stenosis with spinal cord or nerve compression and loss of neurologic function

References:

1. More about Vertebroplasty and Kyphoplasty
2. Percutaneous Vertebroplasty/Kyphoplasty.pdf.
3. Detailed source of Vertebroplasty and Kyphoplasty.pdf
4. Balloon kyphoplasty in the management of vertebral compression fractures
5. A Randomized Controlled Trial of Vertebroplasty for Osteoporotic Spine Fractures