Balloon kyphoplasty, vertebroplasty and vertebral body augmentation are minimally invasive surgical procedures used to treat painful Vertebral Compression Fractures (VCF). These procedures help to quickly reduce severe pain, stabilize the VCF and restore lost height and/or shape of the broken vertebral body.
A VCF is a type of spinal fracture that can be caused by osteoporosis; a metabolic disease that gradually weakens bone density and increases the risk for fractures in the spine, wrist and hip. Osteoporosis and osteopenia affect an estimated 54 million Americans, according to the National Osteoporosis Foundation.1 Left untreated, osteoporosis can progress silently and painlessly until bone fractures.
Originally developed in France in 1986, vertebroplasty became available for use in the United States in 1991. Vertebroplasty is a percutaneous (through the skin) minimally invasive procedure performed to treat painful vertebral compression fractures, as well as strengthening vertebral bodies at risk for fracture. The surgery involves injecting an orthopaedic bone cement into the fractured vertebral body.
How is Vertebroplasty Performed?
Under light sedation or general anesthesia, a special bone needle is passed slowly through the soft tissues of the back toward the VCF. Image guided fluoroscopy (real time x-ray), along with a small amount of x-ray dye, allow the surgeon to see the position of the needle at all times.
A small amount of orthopaedic bone cement, called polymethylmethacrylate (PMMA), is pushed through the needle into the vertebral body. PMMA is a medical grade bone cement that has been used for many years in a variety of orthopaedic procedures.
The cement is sometimes mixed with an antibiotic to reduce the risk of infection and a powder containing barium or tantalum, which allows it to be seen on the x-ray.
When the cement is injected, it is like a thick paste, but it hardens rapidly. Usually, the fractured vertebral body is injected on both the right and left sides, just off the midline of the back. Within a few hours, patients are up and moving around. Most go home the same day of surgery.
Balloon Kyphoplasty is a newer minimally invasive surgical treatment for painful vertebral body compression fractures sometimes associated with osteoporosis. Kyphoplasty is unique in that it utilizes a balloon technology that expands the compressed bone to help restore lost vertebral body height while creating a void into which bone cement is injected. In addition to relieving fracture pain, kyphoplasty can stabilize the fracture, restore lost vertebral height, and reduce deformity.
How is Kyphoplasty Performed?
Kyphoplasty is performed under local or general anesthesia. Using fluoroscopic image guidance, two small skin incisions are made, and a probe is inserted into the vertebral body space where the fracture is located. The bone is drilled and a balloon, called a bone tamp, is inserted on each side. These balloons are then inflated with contrast medium (to be seen using fluoroscopy, real time x-ray) until each balloon expands to the desired height, and then are removed. The balloon does not remain in the patient—it simply creates a cavity for the cement and also helps expand the compressed vertebral body bone.
The spaces created by the balloons are filled with the same orthopaedic bone cement used in vertebroplasty—and this cement binds and stabilizes the fracture. The cement hardens quickly, providing strength and stability to the vertebra, restoring height, and relieving pain.
A vertebral augmentation system called the Kiva® System is different from vertebroplasty and kyphoplasty. This minimally invasive treatment for thoracic (mid-back) and lumbar (low back) spinal compression fractures uses a flexible continuous loop-like spinal implant.
The Kiva procedure is performed under local or general anesthesia. Fluoroscopic image guidance is used during the procedure to visualize spinal anatomy and guide placement of the Kiva device. During the percutaneous (through the skin) procedure, the implant is delivered through a small, single incision. After the implant is in place, bone cement is injected, and the implant is removed.
Kiva offers many potential benefits, including:
Limitations in the traditional treatment of vertebral compression fractures (VCFs) have led to the refinement of vertebroplasty, balloon kyphoplasty, and vertebral augmentation (ie, Kiva® System). Each procedure provides options for treatment of vertebral compression fractures and may help relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the “downward spiral” of untreated osteoporosis.
Additional benefits of these procedures include:
Dr. Abitbol has provided a short and concise treatise on the subject of vertebroplasty and kyphoplasty. These two management strategies are becoming increasingly popular for the management of vertebral osteoporotic compression fractures that are refractory to medical management. Controversy often exists in medicine, and this area is no exception. Dr. Abitbol, however, has clarified the issues at hand, while providing an excellent informative article.