Balloon Kyphoplasty For Vertebral Wedging

Balloon kyphoplasty is performed under local or general anaesthesia assisted by fluoroscopy. One or more levels of the spine can be treated in one session.

The fractured vertebra is accessed through a small incision in the patient's back. A hand drill is used to create a channel through which one or two balloon-like devices (inflatable bone tamps) can be inserted into the medullary space. The inflatable tamp is positioned in the vertebral body and filled with a radiopaque contrast medium for visualisation. The balloon is slowly inflated until the normal height of the vertebral body is restored or the balloon reaches its maximum volume. The balloon is then deflated and the cavity created filled with cement (typically polymethylmethacrylate, PMMA) at a low pressure.

Kyphoplasty is an elective surgery designed to achieve three main goals in patients suffering from painful vertebral compression fractures:

• Reduce or eliminate back pain
• Prevent further collapse of the fracture, thus avoiding an increase in spinal deformity and progression of postural problems
• Restore normal spinal alignment, thus improving the patient's posture.

Kyphoplasty is minimally invasive, percutanuous (requires no surgical incision), and can be performed under local or general anesthesia as an inpatient or even outpatient procedure. The duration of the procedure is usually between 30 to 45 minutes.

A typical Kyphoplasty procedure is performed as follows:

• The patient is lying prone (on his/her belly) on the operating table, either completely asleep (general anesthesia) or sedated (local anesthesia).
• Through two tiny skin openings in the back (each opening about 1/6 or an inch long) specialized tubes are inserted directly into the fractured vertebra. This is done under guidance by a specialized X-ray imaging to allow precise placement.
• Through each tube, a special balloon is inserted into the collapsed vertebra. Once the balloons are in place, they are sequentially inflated with a liquid under X-ray guidance with the goal of re-establishing the original height of the collapsed vertebra.
• The balloons are then deflated, leaving an empty cavity within the bone that has now been expanded.
• At this stage, highly viscous bone cement is inserted into the vertebra through both tubes under X-ray guidance to assure the cement is not leaking out of the vertebra. The cement hardens within minutes.

The patient is allowed to get out of bed and walk as soon as he or she is awake. Typically patients are discharged from the hospital the next day and the vast majority of patients require no strong pain medications by 3 to 4 days after the surgery. Physical therapy, when needed for strengthening of the spinal muscles, can usually be safely initiated within two weeks following the kyphoplasty surgery.