General Nuclear Medicine:
Vertebroplasty and Kyphoplasty
Vertebral Fractures
Vertebral fractures are quite common. In fact, approximately 250,000
vertebral fractures are diagnosed in the United States each year.
Most of the diagnosed vertebral fractures occur in older people
who have fragile bones due to osteoporosis, the loss of calcium
from bones which results in weakened bone structure. Many of these
patients do not realize they have osteoporosis. Vertebral fractures
often occur with minor accidents, such as a minor fall.
Treatment for Vertebral Fractures
While some vertebral fractures do not cause significant pain, others
can be very painful and disabling. Standard treatments for a vertebral
fracture include pain medication, progressive activity and the use
of a brace for support.
Even when the fracture has healed, there remains a high risk of
a new fracture. In fact, research shows that a patient who experiences
an osteoporotic fracture is five times more likely to suffer additional
fractures. It is important for patients to seek medical treatment
for osteoporosis before it reaches the fracture stage.
Vertebroplasty and Kyphoplasty
To alleviate the pain caused by a vertebral fracture, two types
of minimally invasive procedures are available. Vertebroplasty
and kyphoplasty are most common procedures used for vertebral
fractures that do not improve with pain medication and treatment
with a brace. Both vertebroplasty and kyphoplasty procedures involve
the placement of cement into the fractured vertebrae through small,
minimally invasive incisions in the skin under x-ray guidance.
Vertebroplasty Compared with Kyphoplasty
The goals of vertebroplasty and kyphoplasty are to stop the pain
caused by the bone fracture, to stabilize the bone and to restore
some or all of the lost vertebral body height due to the compression
fracture. While vertebroplasty and kyphoplasty are very similar,
kyphoplasty includes an additional step. Prior to injecting the
cement-like material, a balloon is inserted and gently inflated
inside the fractured vertebrae. The purpose of this step is to restore
height to the bone thus reducing deformity of the spine. Most patients
are able to return to their normal daily activities after either
procedure.
- During vertebroplasty and kyphoplasty, a small
incision is made in the back through which the doctor places a
narrow tube. Using fluoroscopy to guide it to the correct position,
the tube creates a path through the back into the fractured area
through the pedicle of the involved vertebrae.
- During kyphoplasty, the physician inserts a special balloon
through the tube and into the vertebrae, then inflates it. As
the balloon inflates, it elevates the fracture, returning the
pieces to a more normal position. It also compacts the soft inner
bone to create a cavity inside the vertebrae. The balloon is then
removed.
- During vertebroplasty and kyphoplasty, the physician
uses specially designed instruments to fill the cavity with a
cement-like material called polymethylmethacrylate (PMMA).
- After being injected, the material hardens, stabilizing the
bone.
Vertebroplasty and kyphoplasty are performed under local or general
anesthesia. Patients may have to spend one day in the hospital after
the procedure. Patients should not drive until they are given approval
by their physician. If a patient is released the day of the their
surgery, he or she will need to arrange for transportation home
from the hospital
Recovery
For some patients, pain relief is immediate. For others, the elimination
or reduction of pain take a few days. Once at home, patients can
resume their normal activities, although strenuous exertion should
be avoided for at least six weeks.
For more information about vertebroplasty
and kyphoplasty at The Miriam Hospital, call 401-793-4450 or
e-mail MLCampbe@Lifespan.org.
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