Thoracic kyphoplasty is a minimally invasive surgical procedure designed to treat painful vertebral compression fractures (VCFs) in the middle section of the spine. These fractures, often resulting from osteoporosis, cause the vertebral bone to collapse, leading to intense pain and spinal deformity. The procedure stabilizes the fractured bone and reduces the risk of further collapse, typically used when conservative treatments like bracing or pain medication have been ineffective.
Defining Thoracic Kyphoplasty and Its Purpose
A vertebral compression fracture occurs when a spinal bone collapses, most frequently in the thoracic spine (the middle section running from the neck to the abdomen). This collapse often causes a change in the natural curvature of the spine, known as kyphosis, resulting in a forward hunching posture. The pain arises from micro-movements within the fractured bone segments and pressure placed on surrounding nerves.
The primary purpose of thoracic kyphoplasty is to address severe pain and prevent the progression of spinal deformity. By stabilizing the fractured bone, the procedure aims to reduce or eliminate the pain caused by instability. A unique aspect of kyphoplasty, compared to vertebroplasty, is its goal of restoring some lost vertebral height and correcting the kyphotic curvature.
Kyphoplasty achieves height restoration by first inserting a balloon into the collapsed vertebra to create a cavity. This step gently pushes the fractured bone back toward its original position before stabilization. The creation of this internal cavity also allows the subsequent stabilizing material to be injected at a lower pressure, which can potentially reduce the risk of the material leaking outside the vertebra. Patient selection focuses on individuals with recent, painful fractures who have not found relief through non-surgical methods.
The Surgical Mechanics
The kyphoplasty procedure is performed in a hospital or outpatient setting and generally takes about one hour for each vertebra treated. The patient is positioned face-down on the operating table, and the procedure is conducted through small, minimally invasive incisions. The surgeon uses fluoroscopy, an imaging device providing real-time X-ray guidance, to navigate the instruments safely.
A specialized hollow needle, or cannula, is advanced through the incision and guided into the fractured vertebral body. Once positioned correctly, a small orthopedic balloon is inserted and gently inflated. As the balloon expands, it compacts the soft inner bone and elevates the endplates of the vertebra, creating an internal void and restoring vertebral height.
The balloon is then deflated and removed, leaving the created cavity inside the vertebra. This space is filled with a specialized bone cement, typically polymethylmethacrylate (PMMA), injected under carefully monitored low pressure. The cement material hardens quickly, often within minutes, providing an internal cast that stabilizes the entire vertebral structure. Fluoroscopy is maintained throughout the injection process to ensure the cement is contained within the bone and prevent leakage.
Immediate Post-Operative Period
Following the procedure, the patient is transferred to a recovery room where medical staff monitor them for a few hours. The team ensures there are no adverse reactions to the anesthesia or the injected bone cement. Many patients report a significant reduction in fracture pain almost immediately, which is a primary benefit of the stabilization.
Patients are encouraged to begin mobilizing quickly, often able to walk within an hour of the procedure. This early movement is important for recovery and helps prevent complications associated with prolonged bed rest. The hospital stay is usually brief, with many procedures performed on an outpatient basis, allowing the patient to go home the same day.
If an overnight stay is recommended, it is primarily for observation, particularly for patients with other health concerns or if multiple vertebrae were treated. Soreness at the incision site can be managed with ice packs and prescribed pain medication. Patients must arrange for a ride home, as driving is restricted in the immediate 24-hour period following the procedure.
Long-Term Recuperation and Activity Restrictions
Once discharged, long-term recuperation focuses on safely integrating back into daily life while allowing the treated bone to incorporate the cement stabilization. Most patients can return to light daily activities, such as walking and self-care, within 24 to 48 hours. Full recovery requires caution and adherence to specific activity restrictions to prevent complications or damage to adjacent vertebrae.
For four to six weeks, patients are advised to refrain from strenuous activities and avoid certain spinal movements. Restrictions commonly include avoiding heavy lifting (defined as anything over five kilograms) and movements involving excessive bending or twisting of the back. These limitations protect the treated area and allow surrounding structures to adjust to the new spinal mechanics.
Follow-up appointments, often scheduled around two weeks post-procedure, allow the surgeon to assess the patient’s pain levels and physical function. Follow-up imaging, such as X-rays, may be performed to confirm the stability of the cemented vertebra. Physical therapy or rehabilitation may be recommended to strengthen the back muscles and improve overall mobility, aiding a complete return to normal activities after the initial six-week period.