Kyphoplasty

Kyphoplasty is a minimally invasive spinal surgery procedure used to treat painful, progressive vertebral compression fractures (VCFs). A VCF is a fracture in the body of a vertebra, which causes it to collapse. In turn, this causes the spinal column above it to develop an abnormal forward curve. VCFs may be caused by osteoporosis (an age-related softening of the bones) or by the spread of tumor to the vertebral body. Certain forms of cancer can also weaken bone and cause the same problems.

Technique

Kyphoplasty involves the use of a device called a balloon tamp to restore the height and shape of the vertebral body. This is followed by application of bone cement to strengthen the vertebra. The procedure is performed with the patient lying face down on the operating room table and under intravenous sedation. Two x-ray machines are used to show the collapsed bones.

To begin, the surgeon makes two small the back. A tube is inserted into the center of the vertebral body to the site of the fractured bone. The balloon tamp is then inserted down the tube and inflated. This pushes the bone back to its normal height and shape.

Inflation of the balloon creates a cavity in the vertebral body, which the surgeon fills with bone cement. When the cement hardens, the tubes are removed. The incisions are closed with a single stitch, and patients usually go home the same day. Patients can go back to all normal activities of daily living as soon as possible with no restrictions.

It is recommended that kyphoplasty be performed soon after a VCF happens to best restore vertebral body height and size. After kyphoplasty, severe osteoporosis may cause other fractures at other levels of the spine. All patients must take bone-strengthening medications during treatment. If more vertebrae collapse, kyphoplasty can be used at those other levels. Kyphoplasty tends to help prevent additional fractures by keeping the spine aligned in its native upright position.

Outcomes

Early results show kyphoplasty is a safe and effective method to relieve pain and correct the deformity associated with an osteoporotic VCF. More than 95% of patients rate their treatment a success. Patients are able to return to all of their previous activities, and typically do not need any form of physical therapy or rehabilitation. Because bone cement hardens within 15 minutes, there is really no healing that needs to happen from the patient's standpoint.

Earlier we were doing a vertebroplasty, where a needle is inserted into the fractured vertebral body, and cement is injected. This cement goes into the fracture lines and sets within 10 minutes and provides immediate mechanical stability and the patient's pain is relieved. This is a much simpler procedure less costly than kyphoplasty and provides equal amount of pain relief however the vertebral height is not regained as much as in kyphoplasty. Hence we still prefer this procedure for the patient who can't afford kyphoplasty.

We have so far performed 30 cases of vertebroplasty and 10 cases of kyphoplasty. There is a instant relief of pain in all the patients and no complication whatsoever seen so far. Following our some picture of last case done by us on 10/03/08 . The patient Mrs.Mohini Sahani is 70 years old female with sudden onset of backpain, with girdle sensation around her waist, her x-ray shows multiple fractures in the spine but her MRI confirmed that the fresh fracture was at D-12 level, which was also the site of girdle pain clinically. We performed kyphoplasty using single balloon, this cuts the cost by half and also the surgery becomes more simple. Post operatively the patient's pain was completely relieved and she resumed her routine activity from next day.

Considering that this is a very vast topic we would like to discuss what is new in the management to make a brief public information presentation. Fractures of spine can be very serious with paralysis and loss of control over bladder and bowel, in some but generally they are minor with no neurological involvement. Fractures of cervical spine (neck) and thoracic spine (chest) have more chances of being associated with paralysis then the lumbar spine (lower back).

Immediate treatment is in form of care of the patient's vitals like breathing (airway potency), blood pressure, oxygen saturation etc. followed by detailed examination and investigations like x-rays, CT scan and MRI. Patient's without instability of the spine mostly can be treated conservatively by medicines and braces (belts/ collar) but the unstable fractures, specially associated with paralysis generally require surgery, in form of reduction of the spine, decompression of the nerves (spinal cord) and stabilization with spinal fusion by the plates or pedical screws and rods or cages etc.

Patient must immediately consult the spine surgeon to avoid the complications and achieve early recovery. Here are some examples of the latest fracture management performed by us.

1 st case: Mr. Ramesh is 35 years old male, sustained fracture of D-12 by fall from height. The vertebral body was collapsed anteriorly (anterior height reduced by 40% and angle 45%). The fracture was reduced by USS, Synthes pedical schanz screws and clamps, a special funnel was introduced through the pedical into the fractured vertebral body to push bone graft, to keep it jacked up. No spinal fusion was performed hence the mobility shall be maintained.

Post operative X-ray pictures: