Vertebroplasty / Kyphoplasty

GENERAL INFORMATION 

Osteoporosis is a common disorder that causes bone loss and may lead to fractures.  It occurs with normal aging or may be associated with certain diseases such as diabetes or hyperthyroidism.  Chronic steroid usage, smoking, or calcium and vitamin-D deficiency may also cause osteoporosis.  It affects 25 million Americans of whom 80% are women. Thin women of northern European heritage are at high risk especially if they have experienced an early menopause.  Bone mass is lost each year and gradually all bones become weak and at risk for fracture even with minor trauma.  The hip, spine, and wrist are common sites of fracture in osteoporotic bones.

 The best approach to osteoporosis is prevention.  This must begin in youth and early adulthood by maximizing bone mass through exercise and adequate calcium and vitamin-D dietary intake and the maintenance of normal menstrual cycles.  There are several drugs in addition to calcium and vitamin D, which are now utilized to slow bone loss.  They include estrogen replacement, biphosphonates (Fosamax, Actonel), serum estrogen receptor modifiers (Evista), Calcitonin (Miacalcin nasal spray) and parathyroid hormone (Forteo).

 Many men and women never realized they have osteoporosis until they sustain a fracture.  Osteoporotic fractures will heal with appropriate treatment (cast, brace, or surgery). People with one fracture are likely to sustain additional fractures and should be evaluated and receive osteoporosis treatment to minimize this risk.  Treatment should include drug therapy, exercise and fall prevention.

 Vertebral compression fractures are common in people with osteoporosis.  In 1996  700,000 vertebral fractures occurred in the United States.  In some cases the fracture causes only minimal pain and heals in 6-12 weeks with rest, medication and a brace.  In other cases the pain is severe and significantly limits function despite medical intervention.  Approximately 150,000 patients are hospitalized each year for severe compression fractures.  Some patients may develop persistant pain and progressive spinal deformity, impairment of respiratory and gastrointestinal function and a sleep disturbance.  Patients with severe symptoms may benefit from a new treatment (vertebroplasty or kyphoplasty) which may reduce the pain and disability from vertebral compression fractures.

INSTRUCTIONS  

You should not have anything to eat or drink for at least eight hours prior to your procedure because you will be receiving intravenous sedation during the procedure.    A friend or relative must be with you or available to bring your home.  Driving is prohibited.  The procedure is described in greater detail below. If you have more questions please do not hesitate to ask the day surgery staff or your doctor at the time of the procedure.

Vertebroplasty 

Vertebroplasty is a minimally invasive, outpatient procedure for treating painful vertebral compression fractures.  An x-ray machine called fluoroscope or C-arm is used to guide a needle into the fractured vertebrae.  A special bone cement (methylmethacrylate) is injected and hardens within the bone providing pain relief and stability.  80-90% of patients report satisfactory pain relief after the procedure.  Before undergoing vertebroplasty you must have a thorough evaluation of your osteoporosis and be receiving appropriate drug therapy.

Kyphoplasty

 Kyphoplasty is a more recent modification of vertebroplasty.   It contains an additional step which inserts a balloon into the fractured vertebrae which is then inflated to attempt to reduce the collapse before the bone cement is injected. 80-90% of patients also report satisfactory pain relief after the procedure.

THE PROCEDURE

 You should not have anything to eat or drink for at least 8 hours prior to the procedure, because you may be receiving intravenous sedation during the procedure.  Please bring with you any X-ray studies you have at home.  After registering, a nurse will complete preparations for the procedure.  In the procedure room you will be positioned on the table on your side or stomach. After the skin is cleaned with iodine and is numbed with local anesthesia a needle will be inserted into the vertebrae.  The fluoroscope is used to guide exact placement.  When the needle is correctly positioned the bone cement is injected and allowed to harden.  The procedure usually takes about 60 minutes depending upon the number of vertebrae which will be treated. You will be given additional medication to help you relax and remain still during the procedure.  At the completion of the procedure you will be returned to the Day Surgery Unit.  After the sedative medication has worn off, discharge instructions are reviewed and someone can bring your home. .   A friend or relative must be with you or available to bring you home.  Driving is prohibited.

After the procedure

 The discomfort produced during insertion of the needle may take several days to subside.  It can be treated with rest, an ice pack and/or Tylenol or Advil.  Your doctor may choose to give you a stronger pain medication if appropriate.  A back support can be used if it helps you to feel comfortable but is not necessary.  You can resume your regular activity gradually as tolerated.  There are no special restrictions but you should not overexert yourself. Use care when walking to prevent a fall.  If you feel unstable ask your doctor for a referral to physical therapy to work on balance.

RISKS and SIDE EFFECTS

 There are a few potential risks and side effects, which you should understand.  Infection in the bone can occur.  You will be given antibiotics prior to the procedure to minimize this risk.  Bleeding and nerve damage have been reported but are very rare.  Because you are awake during the vertebroplasty or kyphoplasty your doctor can carefully monitor your neurologic status during needle placement.  If your fracture is in the thoracic region of the spine the needle used for injection must pass close to the lung.  Sometimes an air leak from the lung can occur.  If the leak is large a tube may need to be inserted until the leak seals. If too much cement is injected it could spread outside of the bone and cause problems with neurologic function or breathing.  The amount and location of the cement injected is carefully measured and monitored using the fluoroscope to minimize this risk.  Not all patients will find relief of their pain and fractures can occur at other sites in your spine.

Post Vertebroplasty Instructions

1.      You may experience discomfort for several days following the procedure.  Rest, ice, pain medications and anti-inflammatories will minimize discomfort during this time. 

2.      Restrict your activities as necessary but don't remain in bed all the time. 

3.      You may use a brace if you have one if it makes you feel more comfortable but it is not necessary. 

4.      The dressing may be removed in the day after the procedure. 

5.      Any unusual or new symptoms (for example fever, weakness, numbness or a change in your bowel or bladder function) should be reported to your physician immediately or you should contact emergency room for further evaluation. 

6.      Call your doctor's office tomorrow and arrange a follow-up appointment in (4-6)  weeks.