Kyphoplasty is a medical procedure that treats vertebral compression fractures, which are breaks in the bones of the spine. These fractures often result from conditions like osteoporosis, cancer, or trauma. Its primary aim is to address pain, stabilize the affected vertebra, and potentially restore lost height. This minimally invasive approach helps patients regain function and reduce discomfort.
What is Kyphoplasty?
Kyphoplasty is a minimally invasive surgical procedure for painful vertebral compression fractures. During the procedure, a patient lies face down, and a small incision, typically half an inch, is made over the affected area. A narrow tube is then inserted through this incision and guided into the fractured vertebra using X-ray imaging for precise placement.
A specialized balloon, known as a bone tamp, is then inserted through the tube into the fractured bone. This balloon is gently inflated inside the vertebra, which creates an open cavity and helps to restore some of the collapsed bone’s height. After creating this space, the balloon is deflated and removed, leaving the newly formed cavity. Bone cement, usually polymethylmethacrylate (PMMA), is then injected into this cavity, which quickly hardens and stabilizes the fractured vertebra, acting as an internal cast.
Defining and Measuring Success
Success is primarily evaluated by pain reduction. A significant percentage of individuals, estimated around 92%, report improved pain relief following the procedure. Immediate pain relief is common, often experienced within 48 hours, or even sooner.
Beyond pain, success is also measured by improvements in mobility and overall function. Many patients experience a return to their regular activities shortly after the procedure. Studies indicate that functional measures, such as the ability to move independently, show noticeable improvement within three months after surgery.
Restoration of vertebral height and correction of kyphosis, or the forward curvature of the spine, are also important indicators of success. Kyphoplasty aims to re-expand the compressed vertebra, and research shows it can restore between 47% and 97% of lost vertebral height in many patients. Some studies have observed a mean increase of 45% in vertebral height post-procedure. This height restoration can also help improve the kyphotic angle, with some studies reporting over 50% improvement if the procedure is performed within three months of the fracture.
Factors Affecting Outcomes
Several factors influence kyphoplasty’s success. The patient’s overall health and underlying conditions play a role; for instance, osteoporosis, which weakens bones, is a common cause of these fractures, and its severity affects bone response. The age of the vertebral compression fracture is also a factor, as kyphoplasty is more effective in restoring vertebral height and correcting kyphosis if performed within three to six months of onset.
The type of fracture also matters, with osteoporotic fractures generally having different characteristics than those caused by trauma or cancer. The number of vertebrae involved can influence the procedure’s complexity and overall outcome, as treating multiple levels may present different challenges. The surgeon’s experience and the precision of cement injection also impact effectiveness and minimize potential complications.
Potential Risks and Complications
While kyphoplasty is generally safe with a low complication rate, typically less than 4%, some risks exist. One concern is bone cement leakage, where injected polymethylmethacrylate (PMMA) moves beyond the fractured vertebra. Although often asymptomatic, in rare instances, cement leakage can lead to increased pain if it seeps near a nerve root or, in extremely rare cases, cause serious issues like pulmonary embolism if it enters the bloodstream.
Other general surgical risks, though uncommon, include infection at the incision site, excessive bleeding, or adverse reactions to anesthesia. A less common but serious risk is nerve damage or spinal cord injury, which could result in tingling, numbness, weakness, or even paralysis, typically due to misplaced instruments or cement leakage onto neural structures. There is also a possibility of new fractures occurring in adjacent vertebrae due to altered load distribution after the treated vertebra is stabilized.