What is Kyphoplasty?
Balloon kyphoplasty, another term for kyphoplasty, is a procedure in which compression fractures of the spine are treated. When there is a compression fracture, part, or all, of the spine collapses. Osteoporosis is the most likely cause of bone thinning. Pain that is disabling and severe, lasting longer than a couple of months that does not improve with physical therapy, bed rest, or pain medicines might need to be corrected with surgery. Other reasons for kyphoplasty include cancer or injuries that break the spine. During the procedure, the patient lies face down upon the table while the numbing medicine is applied. Then a needle is placed into the bone, through the skin. The doctor is guided in the surgery with “real-time x-ray images”. Then, “a balloon is placed through the needle, into the bone, and then inflated” in order to restore the vertebrae height. Cement is injected to prevent future collapse. Aside from the local anesthetic, a patient may receive medicine to fall asleep or relax. Some might need general anesthesia, though.1
Risks and Recovery
There are always risks with vertebroplasty and kyphoplasty surgery, such as bleeding, infection, allergy to medications, breathing and heart problems from the general anesthesia, nerve injury, or “leakage of the bone cement into surrounding area”. Doctors need to know if patients are pregnant, if they drink alcohol, and what medications the patient takes. Prior to surgery, patients are typically advised to “stop taking aspirin, ibuprofen, Coumadin (warfarin), and other drugs that make it hard for your blood to clot”. Patients should not eat or drink before the surgery, and they can go home the same day. Kyphoplasty recovery time is about a day, at least in terms of bed rest. Regular activities can slowly resume the next day, but strenuous activities or heavy lifting should be avoided for 6 weeks.2 Kyphoplasty can be used to “reverse deformity that can occur as a result of kyphosis (a curvature of the upper back)” as well as repairing “lost bone height”.3 If there is an established spine deformity, this surgery cannot correct that. Some osteoporosis patients are not candidates, either. The patients best suited to this procedures are those who are “experiencing painful symptoms or spinal deformities from recent osteoporotic compression fractures”, but the surgery should be performed “within 8 weeks of when the fracture occurs for the highest probability of restoring height”.4
Vertebroplasty and Kyphoplasty
Percutaneous vertebroplasty is another procedure in which there is an injection of bone cement through a skin hole into a fractured vertebra. In terms of kyphoplasty vs. vertebroplasty, kyphoplasty is just a variation of vertebroplasty, and it uses the balloon to “create a void” prior to injecting the cement. No balloon is used in vertebroplasty.5 Because vertebroplasty and kyphoplasty are similar procedures, the risks are similar as well. Anesthesia reaction and infection are possible. Spinal cord injury and nerve damage from “malpositioned instruments” could occur. Additionally, if the polymethylmethacrylate (PMMA) leaks into the epidural space or veins, spinal cord compression and nerve injury may happen. Some patients may have an “allergic reaction to the solution used to see the balloon on the X-ray image as it inflates”. It is unknown if either surgery would “increase the number of fractures at adjacent levels of the spine”. Because osteoporosis is progressive, additional fractures are still possible.6 There are additional adverse effects possible with the surgeries, including tingling, numbness, headache, pulmonary embolism, and paralysis. The effectiveness of vertebroplasty and kyphoplasty is under dispute.7 The main differences of vertebroplasty vs. kyphoplasty are the use of the balloon in the latter, and, in the former, “the doctor guides the needle using fluoroscopy”. Both procedures take an hour or two to complete. Experts have determined that “there is no strong evidence that either kyphoplasty or vertebroplasty is better than nonsurgical treatment, such as pain medicine, rest, and exercise”, and that kyphoplasty could be “an option for some people, but they do not recommend vertebroplasty”. Problems compound when “more than one vertebra is treated”.8
Patients may wonder if it is possible to return to conservative care, such as chiropractic, after vertebroplasty and kyphoplasty surgeries. As long as the chiropractor is aware that the patient has had surgery, and as long as they are trained in handling such cases, it can be safe. Patients who have had surgery should contact their physician before any spinal manipulation, though. Recovery and healing time are important. Usually a 6-month waiting period is safe, and the surgeon may be able to provide a referral to an appropriate chiropractor.9 Prior to any surgical intervention, because of the risks, patients should explore all of their conservative care options, including chiropractic. Lifestyle changes, dietary changes, and exercises may also be suggested for patients, before medications and vertebroplasty and kyphoplasty are recommended.10 Aside from spinal manipulation, patients may be offered traction, muscle stimulation, soft tissue massages, or even acupuncture.11