Kyphoplasty for Spinal Fractures from Osteoporosis

Kyphoplasty for Vertebral Compression Fractures

Kyphoplasty is an elective surgery designed to achieve three main goals in patients suffering from painful vertebral compression fractures:

  1. Reduce or eliminate back pain
  2. Prevent further collapse of the fracture, thus avoiding an increase in spinal deformity and progression of postural problems
  3. Restore normal spinal alignment, thus improving the patient's posture.

Kyphoplasty is minimally invasive, percutanuous (requires no surgical incision), and can be performed under local or general anesthesia as an inpatient or even outpatient procedure. The duration of the procedure is usually between 30 to 45 minutes.

Description of Kyphoplasty Surgery
A typical Kyphoplasty procedure is performed as follows:

  • The patient is lying prone (on his/her belly) on the operating table, either completely asleep (general anesthesia) or sedated (local anesthesia).
  • Through two tiny skin openings in the back (each opening about 1/6 or an inch long) specialized tubes are inserted directly into the fractured vertebra. This is done under guidance by a specialized X-ray imaging to allow precise placement.
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  • Through each tube, a special balloon is inserted into the collapsed vertebra. Once the balloons are in place, they are sequentially inflated with a liquid under X-ray guidance with the goal of re-establishing the original height of the collapsed vertebra.
  • The balloons are then deflated, leaving an empty cavity within the bone that has now been expanded.
  • At this stage, highly viscous bone cement is inserted into the vertebra through both tubes under X-ray guidance to assure the cement is not leaking out of the vertebra. The cement hardens within minutes.

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Balloon Kyphoplasty

The patient is allowed to get out of bed and walk as soon as he or she is awake. Typically patients are discharged from the hospital the next day and the vast majority of patients require no strong pain medications by 3 to 4 days after the surgery. Physical therapy, when needed for strengthening of the spinal muscles, can usually be safely initiated within two weeks following the kyphoplasty surgery.

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General Results of Kyphoplasty
Results from large series of kyphoplasty procedures performed primarily for compression fractures caused by osteoporosis demonstrated immediate to early (less than 2 weeks) pain relief of 80-90% in about 90% of patients. Restoration of vertebral height and spinal alignment is more variable between patients and across studies, but correction of height is reported overall to be a correction of about 50% of height lost in 70-90% of patients. Results also demonstrate significant improvements in terms of functional performance after kyphoplasty.

Less data is available for kyphoplasty results in patients with other conditions affecting the spine, such as multiple myeloma and metastatic carcinoma. Nevertheless, significant pain reduction, height restoration, and functional improvement have consistently been reported for patients with compression fractures from these conditions as well.

Types of Compression Fractures Appropriate for Kyphoplasty
This procedure should be considered as a treatment option for most patients with significant back pain and deformity resulting from compression fractures due to weakened bone structure. In the majority of cases, patients have weak bone (also known as low bone density, osteopenia, or osteoporosis) because of age-related bone loss. Although this condition affects primarily older women, aging men are also at risk.

Younger patients who may benefit from kyphoplasty are those with vertebral compression fractures due to other diseases that have weakened their spine. Such conditions include:

  • Multiple Myeloma
  • Lymphoma
  • kidney disease
  • Metastatic carcinoma

Certain medications (such as steroids) can also contribute to weakening the bone in younger patients. In most cases, patients with weak bone due to any of the above listed conditions can suffer spinal compression fractures with only minimal or no trauma. Often times, a minor fall from standing height, or even a simple bending or twisting motion can result in a compression fracture.

In contrast to patients with weak bone due to osteoporosis, cancer, or any of the above listed conditions, younger patients sustaining stable compression fractures from high energy trauma (such as a motor vehicle accidents) are generally not good candidates for kyphoplasty. In this group of patients, bone density is usually normal and the risk of further collapse while the fracture is healing is very small. Those patients are therefore usually treated non-operatively with bracing for support while the fracture is healing.

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Written by Rafael Levin, MD