Thoracic kyphoplasty is a minimally invasive medical procedure designed to address vertebral compression fractures in the middle section of the spine. Its primary purpose is to reduce pain, stabilize the fractured bone, and restore some of the lost vertebral height. This procedure offers a targeted approach to treating specific spinal injuries, helping to improve a patient’s overall spinal alignment and comfort.
What Are Vertebral Compression Fractures?
Vertebral compression fractures (VCFs) occur when one or more vertebrae collapse or crack. These fractures are common in the thoracic spine, spanning from the T1 to T12 vertebrae. Approximately 1.5 million VCFs occur annually in the United States, many affecting this region.
The most common cause of VCFs is osteoporosis, a condition where bones become thin, porous, and brittle due to a loss of bone density. This weakening makes the vertebrae susceptible to fractures even from minor stresses, such as coughing, sneezing, or bending forward. Other causes include trauma from falls, car accidents, or forceful jumps, and certain medical conditions like tumors and multiple myeloma.
Symptoms of VCFs include persistent, localized back pain, which often worsens with movement, standing, or walking, and may lessen when lying down. Over time, multiple compression fractures can lead to a loss of height and a rounded, stooped posture known as kyphosis. In severe cases, fragments from a burst fracture can irritate or compress the spinal cord or nerves, causing numbness, tingling, weakness in the limbs, or issues with bladder and bowel control. These fractures can significantly impact quality of life and increase the likelihood of future fractures if left untreated.
The Thoracic Kyphoplasty Procedure
The thoracic kyphoplasty procedure begins with the patient lying face down on an operating table. Local or general anesthesia is administered to ensure patient comfort. Vital signs such as blood pressure, oxygen saturation, and heart rate are continuously monitored.
A small incision, generally about half an inch, is made over the affected vertebral body in the back. Using real-time imaging guidance, such as fluoroscopy or a C-arm, a hollow needle or tube, known as a trocar, is inserted through the pedicle into the fractured vertebra. This imaging allows the surgeon to visualize the needle’s exact position, helping to avoid contact with surrounding structures like the spinal cord.
Once the needle is positioned within the fractured vertebral body, a specialized balloon catheter, also called a balloon tamp, is advanced through the trocar. The balloon is slowly inflated to create an open cavity within the bone and, in many cases, restore some lost vertebral height. After the cavity is created, the balloon is deflated and removed, leaving the newly formed space.
Finally, bone cement, known as polymethyl methacrylate (PMMA), is prepared and injected into the created cavity. The cement is injected slowly, and its consistency and flow are closely monitored to prevent leakage into surrounding areas. This cement hardens quickly, typically within about 5 minutes, forming an internal cast that stabilizes the fractured vertebra. The entire procedure usually takes about one hour for each vertebra treated, and the incision is then closed.
Life After Kyphoplasty: Recovery and Results
Following a thoracic kyphoplasty, patients are observed in a recovery room for an hour or two. Many individuals experience noticeable pain relief within 48 hours, with some reporting immediate improvement. Any soreness from the incision site resolves within two to three days.
Kyphoplasty is performed as an outpatient procedure, allowing patients to return home the same day, although driving immediately afterward is not advised. For the first 24 to 48 hours, it is recommended to rest. Over-the-counter pain medications and ice packs applied to the incision area can help manage any mild discomfort.
Patients are advised to gradually increase their activity levels over the next few weeks. While light activities can be resumed within a day or two, strenuous activities, heavy lifting, and twisting motions should be avoided for four to six weeks to allow the treated vertebra to fully stabilize. Physical therapy may be recommended to strengthen back muscles and improve flexibility and mobility. The procedure has a high success rate, with 92% of patients reporting improved pain relief. Outcomes include significant pain reduction, improved mobility, and stabilization of the fractured vertebra, helping to prevent further collapse and spinal deformity.
Who is a Candidate and Potential Concerns
Candidates for thoracic kyphoplasty present with painful, recent vertebral compression fractures that have not responded to conservative treatments like medication or bed rest. The pain must be directly related to the vertebral fracture, rather than other spinal conditions such as arthritis or disc herniation. Imaging tests, including X-rays, CT scans, and MRI scans, confirm the fracture and rule out other causes of pain. Individuals with osteoporosis, certain spinal tumors, or vertebral hemangiomas may also be considered.
Kyphoplasty may not be appropriate in certain situations. These include fractures not causing severe pain or deformity, active infections, or bleeding disorders. Significant vertebral collapse or tumors that extend into the spinal canal may also preclude the procedure. Pain stemming from conditions other than a compression fracture, such as disc herniation or spinal stenosis, means a patient is not a candidate.
Complications associated with kyphoplasty, though rare, can occur. These include localized bleeding or infection at the incision site. Increased pain, numbness, or tingling can occur if a nerve is irritated or damaged during the procedure. Cement leakage, where the polymethyl methacrylate (PMMA) escapes the vertebral body, is a known concern. Cement leakage into surrounding tissues, the spinal canal, or the systemic venous system can lead to serious issues, such as pulmonary embolism.