Interventional Radiology (IR), Frankford Hospitals
Fractured vertebrae are a common condition, especially in older patients, and they can
be painful and debilitating. Specialists have long sought a less-invasive way to address fractures in vertebrae than the conventional open surgery required for spinal fusion or fixation – and a more effective approach than
the traditional bed rest, pain medications,
and bracing used for most patients with vertebral fractures.
Patients often suffer these cracks and breaks in vertebrae as compression fractures, as
a result of chronic and long-term downward compression of the spine. Patients who have osteoporosis are at greatest risk for these fractures. Broken vertebrae are compromised in such a way that they can shift or compact, in turn squeezing or damaging the spine or
vital nerves emanating from the spine. Patients may become bedridden from these fractures, as a result of severe pain – due to nerve impingement or bone rubbing
on bone – that is felt especially during movement. Hundreds of thousands of Americans suffer compression fractures each year.
In the last several years, interventional radiologists have made available a new procedure to correct this condition, and
it is benefiting many patients. Earlier referred to as vertebroplasty, and now refined into a procedure called kyphoplasty, this treatment can relieve pain
and return mobility without the need for a hospital stay or long postsurgical recovery.
Under imaging guidance, interventionalists can inject orthopedic cement into a fractured vertebra, to correct, reinforce,
and stabilize this bone. The team will typically use x-rays and MR imaging scans to confirm and study the fracture first.
Kyphoplasty normally requires only moderate sedation and a local anesthetic at the needle site. Interventionalists make a small incision in the skin near the fractured vertebra and insert a small tube, through which they
advance a tiny balloon (tamp) at the end of a catheter, which they then inflate to reposition vertebra. This permits them to at least partially restore the height of the vertebra and decrease the deformity in it. The team then passes a needle-like instrument into the space in the vertebral bone, through which it injects an extremely
strong, specially formulated bone cement, which is easily visible on x-ray image.
During the procedure, the specialists introduce the cement slowly, as they monitor the process under a type of operating room
x-ray monitoring capability called fluoroscopy. Seeing the progress of the cement as it fills the fracture decreases the chance that the cement will impinge upon the spinal
canal, the nerve roots, or the vertebral disk. The medical cement solidifies to a state even harder than bone.
With the more recent addition of the balloon-tamp step, the procedure corrects more of the collapse in the vertebra prior
to cementing and can therefore help to remove curvature of the spine that results. In addition, the cement – injected gradually under low pressure in putty form – finds an easier path into the space where
it is needed after the balloon tamp opens this space. (This may also reduce the risk of the cement leaking out of the space.)
The entire procedure, including the time needed for the cement to set, takes only about an hour (longer if additional fractures
are treated in the same session). Patients rest in the recovery area and can return home that same day or after a brief overnight in the hospital.
Though kyphoplasty is still a relatively new procedure, experience so far indicates that most patient experience dramatic
improvement in their pain symptoms. Often this is in the first 24 hours after the procedure. It is not unusual that patients who undergo the procedure are already back on their feet and returning to normal daily activities
within a day.
Interventionalists can perform the procedure for patients with vertebral fractures due to a number of conditions in addition
to osteoporotic compression fracture, including cancer or trauma. And, they can repeat the procedure for patients who experience additional fractures. (Fracture of adjacent vertebrae is a potential complication of kyphoplasty.) Patients are better candidates for kyphoplasty if their fracture has occurred within a few weeks or months prior to evaluation.
The large majority of patients treated with kyphoplasty experience complete or significant pain reduction within the first
week, and the benefits are long lasting. The procedure is dramatically quicker and easier to undergo than conventional, open spinal surgery, and much faster and more
dependable in its results than conventional bed rest treatment.