Kyphoplasty - A Minimally Invasive Approach to the Treatment of Vertebral Compression Fractures.
Last updated Wednesday, February 09, 2005
Considering surgeryWho should consider kyphoplasty for vertebral compression fractures and in what cases? The diagnosis of VCFs is generally suspected in patients over 65 years
of age who suffer develop acute complaints of back pain. Often only
trivial traumatic episodes are involved. There may or may not be
tenderness over that particular area of the spine or minimal tenderness
with an increasingly progressive curve to the spine. Plain X-rays
typically demonstrate the fracture by presence of a fracture line, loss
of bone height, and possibly a kyphotic deformity. Rarely, is
additional imaging required for the acute diagnosis. Often, however, a
CT Scan of MRI is required to eliminate the possibility of a pathologic
fracture (tumor or infection) and to properly classify to fracture.What happens if nothing is done for vertebral compression fractures (best case/worst case scenarios)? Kyphoplasty is not recommended for all VCFs. Some fractures have
minimal associated deformity or pain and are usually stable fractures.
In this case, no treatment is required other than a short period of
activity modification. If, however, a painful VCF is diagnosed and
fails to improve with nonoperative treatment within about two weeks,
then, such individuals may be candidates for the kyphoplasty procedure.
In addition, if the traditional VCF treatments are not successful in
managing the associated pain of if deformity develops, kyphoplasty can
be considered. Preoperative assessment usually includes a series of
plain X-rays, a CT scan (to make sure the injury is a compression
fracture), and MRI scan, and possibly a Bone Scan. Consequently,
referral for kyphoplasty can be initiated through the emergency room
physician, primary care physician, or even in some cases by the patient.What options exist for surgery for vertebral compression fractures? Previous treatment options for management of VCFs include bedrest,
brace wear, analgesic medication, narcotic medications, and activity
modification. All of these options have met with some degree of success
and failure. For the most part these methods have been unsuccessful or
required prolonged period of immobility and functional restriction.
Surgical treatment of VCFs previously included utilization of rod and
screw type instrumentation to stabilize the injured vertebrae and
correct deformity through spinal fusion. This type of procedure is
quite extensive for the treatment of such fractures and, fortunately,
rarely required. Such a fusion procedure is recommended only in cases
where there is associated neurologic deficit (abnormality), adjacent
level fracture, severe deformity or spinal instability, or pathologic
fracture (tumor/infection). Another surgical procedure called
Vertebroplasty has been offered to patients for treatment of VCFs. It,
similarly, attempts to stabilize the fractured vertebrae through the
utilization of methylmethacrylate cement (bone cement), but makes no
attempt at correction of spinal deformity. Therefore, it has met with
limited success and patient satisfaction.
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