Minimally Invasive Treatment of Vertebral Compression Fractures: Vertebral Augmentation Implant, Kyphoplasty, Vertebroplasty

Written by Isador H. Lieberman, MD, MBA, FRCSC

Spinal compression fractures, also known as vertebral compression fractures (or VCFs), may be treated with surgery. Vertebral augmentation implant (Kiva® System), balloon kyphoplasty, and vertebroplasty are three minimally invasive treatments for thoracic (mid-back) and lumbar (low back) spinal compression fractures. These procedures use bone cement to prevent movement at the fracture site.

Vertebral Augmentation Implant

A vertebral augmentation treatment called the Kiva® System is different from vertebroplasty and balloon kyphoplasty. It’s a percutaneous (through the skin) minimally invasive treatment for thoracic (mid-back) and lumbar (low back) spinal compression fractures that uses a continuous loop-like spinal implant.

Like other types of spine surgery, it is performed using image guidance, such as fluoroscopy—similar to real time x-ray that allows the surgeon to guide and view device placement. During the percutaneous procedure, the implant is implanted through a small, single incision. After the device is in place, bone cement is injected, and the device is removed.

Balloon Kyphoplasty

During kyphoplasty (also called balloon kyphoplasty), a thin tube is inserted into the collapsed vertebra (spinal bone). Attached to the tube is a small balloon that, when inflated, moves the broken bone and creates an open space. The balloon is removed, and the space is filled with thick, liquid bone cement.

Balloon kyphoplasty can help relieve back pain and stabilize the vertebral compression spinal fracture. In addition, kyphoplasty may also restore fracture-related lost vertebral height, thus reducing or preventing spinal deformity.

Vertebroplasty

During vertebroplasty, the bone cement is injected into the collapsed vertebral body. The bone cement rapidly sets, hardens and stabilizes the spinal fracture. Vertebroplasty can help to relieve pain and may strengthen other vertebral bodies at risk for fracture.

Vertebroplasty is performed using thin tubes (called cannulas). A cannula is passed through your skin and into the fractured vertebral body. Patients usually go home the same day of surgery, although some may require an overnight stay in the hospital. Stitches are seldom necessary to close the small incision where a cannula was inserted.

Vertebral Augmentation Implant, Kyphoplasty, and Vertebroplasty

These three procedures may reduce or alleviate back pain caused by a thoracic or lumbar vertebral compression fracture. With kyphoplasty or vertebroplasty, there is a risk of bone cement migrating out of place (called extravasation). As with any surgical procedure, there are risks, such as infection. Your interventional physician or spine surgeon will explain the recommended procedure's benefits and risks.

Vertebral Compression Fracture and Spinal Fusion

Sometimes, a vertebral compression fracture does not heal properly. In such a case, your spine surgeon may recommend a procedure that includes spinal fusion. Spinal fusion joins two or more vertebrae together. The surgical procedure may include instrumentation (eg, screws, rods, interbody devices) and bone graft. Once again, your spine surgeon will explain the purpose and goals of the recommended procedure, including the benefits and risks to help you make an informed decision about your health care.

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