Osteoporosis affects millions of Americans and leads to decreased bone mineral density in the spine along with extremity bones such as the wrist and the hip. As a person’s bone
mineral density continues to decrease, people can sustain vertebral compression fractures in the spine leading to significant pain and disability.
Prior to the 1990s, treatment for compression fracture pain consisted of bracing and pain medication. Vertebroplasty was invented in the 1990s as a very effective procedure that is minimally invasive and involves putting bone cement into the fracture for stabilization. In basic terms, it’s like placing an “internal cast”.
What exactly is a vertebroplasty procedure and how does it differ from a kyphoplasty procedure?
Both procedures are performed as outpatients and are minimally invasive, involving very
small incisions where the catheters are placed on either side of the spine. The procedures are performed for the same reason, which is to reduce the pain from a compression fracture in either the thoracic, lumbar or sacral spine.
Millions of these fractures occur annually due to osteoporosis along with cancer related fractures in the spine. Both procedures have been shown to relieve 85 to 95% of a person’s pain immediately. The risks of each procedure are very low, but cannot be ignored. These risks are discussed further below.
The beginning of a vertebroplasty procedure is the same as a kyphoplasty. Patients are given either deep intravenous sedation or general anesthesia and are placed on their stomachs with significant padding. A fluoroscopy machine, which is a real-time form of x-ray, is necessary for accurate placement of the catheters into the fracture.
Most doctors will place a catheter on either side of the fracture with special care being taken to avoid the spinal canal. Once the catheters are in position, this is where the difference between a vertebroplasty and a kyphoplasty is noticed.
For the kyphoplasty procedure, the doctor will then inflate balloons filled with saline into the fracture. These balloons are filled with saline that is noticeable on the x-ray machine so you can see exactly how much they have been filled up. The procedure was invented in the early 2000′s as an intended improvement over vertebroplasty, as it allows some height to be restored with the balloon inflation.
Once adequate inflation has been achieved, the balloons are then deflated and a void is left into which the cement is injected. This empty space created during the kyphoplasty procedure with the balloon inflation allows for a low pressure injection of cement that has a lower risk of leaking outside of the bone. The empty space created allows more cement to be used into a focal area, since the bone was pushed in all directions by the balloons, further stabilizing the area.
With a vertebroplasty procedure, no balloon is utilized and the bone cement is injected as soon as adequate positioning of the catheters has been achieved. Either way, the same type of bone cement is put in and it hardens within about 20 minutes, stabilizing the fracture and achieving pain relief immediately.
How Well do the Procedures Work?
The same amount of pain relief is achieved between vertebroplasty and kyphoplasty, at over 85-90%. Studies have consistently confirmed this with only a couple exceptions in the literature. It is typically a very satisfying procedure, and patients go home the same day.
One should take care to keep the risks in mind, which are small but real. If the cement ends up where it’s not supposed to be, such as in the spinal canal, it can cause neurologic damage. This occurs much less than one percent of the time. There is a risk of anesthesia allergic reaction, infection, bleeding. All of these will be relayed by the pain doctor during the procedure discussion.
If you are experiencing pain from a compression fracture, call Arizona Pain Specialists for help. They have Arizona pain clinics all over the valley and have Board-Certified Arizona pain doctors who have performed thousands of levels of vertebroplasties and kyphoplasties. Most insurance is accepted including Medicare and Medicaid, and all the procedures are done in-house as opposed to a separate surgery center for convenience.
Call 602-507-6550 today for scheduling.