Kyphoplasty Specialist

R. James Warren, MD, MS -  - Interventional Pain Management Specialist

Apollo Pain Management

R. James Warren, MD, MS

Interventional Pain Management Specialist located in Sun City Center, FL

Kyphoplasty

 

What is Vertebral Augmentation? 

A compression fracture, or a break in one of the bones of your spine, can be very painful and debilitating. It may cause extreme pain, deformity, and loss of height. That because a break can result in bone fragments rubbing against each other. We offer a procedure that can help treat such fractures.

Vertebral augmentation, also known as kyphoplasty or vertebroplasty, is a minimally invasive procedure that can be performed to help reduce the pain of compression fracture and restore function. Usually, it can be done as an outpatient, without a hospital stay.

 

What is the purpose of Vertebral Augmentation?

Vertebral augmentation is used to mend recent fractures of the bones of the spinal column or vertebrae. It is most effective when performed within 2 months of a compression fracture, but may be able to provide partial relief if performed within a year. The procedure can be effective in treating people whose bones are weakened by cancer, or whose vertebrae collapse due to osteoporosis, a disease that causes loss of bone density. It can also help relieve pain and improve mobility when other measures fail to provide relief.

 

What is the difference between Kyphoplasty and Vertebroplasty?

Vertebroplasty and kyphoplasty are both types of vertebral augmentation. They are minimally invasive procedures for treating vertebral compression fractures.

- In Vertebroplasty, a cement-like mixture is injected into the fractured bone to give it strength. This stabilizes the fracture and provides immediate pain relief in many cases.

- Kyphoplasty includes an additional step. Prior to injecting the cement-like material, a special balloon is inserted and gently inflated inside the fractured vertebrae. The goal of this step is to open the space and restore height to the bone, thus reducing the deformity of the spine. Kyphoplasty is sometimes referred to as balloon vertebroplasty.

Most patients return to their normal daily activities after either procedure.

 

What happens before the procedure?

Kyphoplasty and vertebroplasty are minimally-invasive procedures that usually require some form of preoperative testing. Depending on your medical conditions, an EKG and/or blood tests may be ordered before the day of your procedure. Imaging tests such as X-rays, CT scans, and/or MRI will help to evaluate the area or areas that need repair.

On the day of your procedure, an intravenous line (IV) will be placed in a vein in your arm to deliver anesthesia. You may also receive pain and anti-nausea medications, as well as antibiotics to prevent infection. You will also be connected to heart, pulse, and blood pressure monitors to optimize your safety during the procedure.

 

How is the procedure performed?

You cannot have anything to eat or drink within 6 - 8 hours of your appointment (clear liquids are allowed until 2 hours before the procedure). If you take medications for diabetes, these medications may need to be adjusted the morning of the procedure. Your primary care physician can help you with this adjustment.

You will need to lie on your stomach for the procedure. The procedure may be performed under General Anesthesia (completely asleep with the support of a ventilator), or under moderate or light sedation (twilight anesthesia similar to what you may receive when having a colonoscopy).

The area in which the needle will be inserted is cleaned and sterilized. A local anesthetic is injected for comfort. Then the following steps are performed for kyphoplasty (for vertebroplasty, steps 2 and 3 are omitted):

1. A hollow needle (trocar) is inserted into your skin. With the aid of fluoroscopy (a type of X-ray), the needle is guided through your muscles and into the correct position into the fractured vertebra (backbone).
2. Next, an inflatable balloon is inserted into the trocar.
3. The balloon is then inflated to create the space needed for the bone cement.
4. Once space has opened up, the mixture is injected to fill it up. X-ray images
performed during the procedure will help confirm that the mixture is distributed properly.
5. Once the cement is in place, the needle is removed.
6. The area is bandaged. You may or may not receive stitches.
7. You are transported to the recovery area for observation

 

 

 

 

 

 

 

 

If only one vertebra is being treated, the procedure usually takes less than an hour.

What happens after the procedure?

Following the procedure, you’ll probably stay in a recovery room for about an hour or two for observation. You may be encouraged to get up and walk. Some soreness is to be expected. An ice pack can help relieve immediate soreness or pain, but you should be feeling better within 24 to 48 hours.

 

You may be able to go home later that day. However, you might need to stay in the hospital overnight for monitoring if:
- there were any complications
- your general health isn’t good

Following the procedure, most people can go back to their normal activities of daily living with no restrictions. You should check with your doctor if there are any activities that you should avoid during the recovery period. You will be asked to schedule a follow-up visit within two weeks to check your progress.

Will the procedure be painful?

The procedure can produce some discomfort. We, therefore, offer anesthesia, either twilight sedation or general anesthesia (completely asleep with the aid of a ventilator). We also employ a local anesthetic at the procedure site for greater comfort.

What are the discharge instructions?

You will receive sedation or general anesthesia, so do not drive or operate machinery for at least 24 hours after the procedure. You may resume your normal diet as tolerated. Do not engage in any strenuous activity for 48 hours. Do not take a bath, shower, swim, or use a hot tub until your bandages are removed, usually within 3-4 days after the procedure. After that, you may shower, but do not immerse your wounds in water for at least 2 – 4 weeks.

Call the office if you have any of the following: severe pain afterwards (different than your usual symptoms), redness/swelling/discharge at the procedure site(s), or fevers/chills.

What are the side effects?

You may experience any of the following side effects after the procedure:

• Leg muscle weakness or numbness may occur due to the anesthesia or sedation
medications. This is a temporary effect and it is not paralysis. If you have any leg
weakness or numbness, walk only with assistance in order to prevent falls and possible
injury. Your leg strength will return slowly and completely.
• Dizziness may occur due to a decrease in your blood pressure. If this occurs, remain
in a seated or lying position. Gradually sit up, and then stand after at least 5 to 10
minutes of sitting. Again, you should walk only with assistance in order to prevent falls.
• Mild headaches may occur. Drink fluids and take pain medications if needed. If the
headaches persist or become severe, call our office.
• Mild discomfort at the injection site often can occur. This typically can persist for a
few days. Take anti-inflammatories or pain medications (such as Motrin or Tylenol)
unless medically contraindicated, and apply ice to the surgical site. Do not get the
dressing wet.

 

What are the risks?

The complication rate for this procedure is very low. Whenever a needle enters the skin, bleeding, infection, or nerve damage can occur. In some rare cases, nerve damage can lead to numbness, weakness, or tingling. Some other serious but extremely rare risks include paralysis and death. You may have an allergic reaction to any of the medications used. If you have a known allergy to any medications, especially x-ray contrast dye or local anesthetics, notify the staff before the procedure takes place. Although the risk is low, if you experience any of the following, a complication may have occurred. You should call our office and proceed immediately to the nearest Emergency Room for evaluation: 

• Severe or progressive pain at the injection site(s)
• Leg weakness that progressively worsens or persists for longer than 8 hours
• Severe or progressive redness, swelling, or discharge from the injections site(s)
• Fevers, chills, nausea, or vomiting
• Bowel or bladder dysfunction (i.e. inability to urinate or pass stool or difficulty
controlling either)
• Bone cement leaking out of position, which may cause a blockage of a vein or artery.
This is an extremely rare, but important complication.
• After a compression fracture, about 10 – 20% of people end up with more
compression fractures.

Complication rates are less than 2% for osteoporotic fractures and up to 10% for malignant tumor-related fractures.

What are the benefits?

Osteoporotic vertebral fractures have associations with increased morbidity, including increased pain and spinal deformity. Other complications that can occur include decreased heart function, increased difficulty breathing, bowel dysfunction, and decreased ability to move. Vertebral augmentation procedures can provide pain relief and improve spinal support function, which may help prevent these complications. People who have a vertebral augmentation procedure may have a better quality of life afterward. They may require fewer pain relievers and be more mobile.