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Kyphoplasty and Vertebroplasty: Minimally Invasive Percutaneous Treatment for Osteoporotic Compression Fractures
Last updated Tuesday, December 02, 2008
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Considering surgeryWhat kinds of surgery are recommended for osteoporotic compression fractures in the spine? Historically, surgery for osteoporotic compression fractures were extensive. These surgeries included a large incision and exposure, and usually a multilevel fusion for stabilization. In general, such extensive surgeries were poorly tolerated by the elderly population. In addition, the weak osteoporotic bone was not ideal for using instrumentation (screws, rods, hooks) which are often used to provide stabilization in fusion.
Recently, the development of minimally invasive techniques allowed patients with osteoporotic compression fractures to avoid such large extensive surgeries. In general, kyphoplasty and vertebroplasty are performed through two small stab incisions, and the patient usually returns home the day of surgery or the day after surgery.
Who should consider kyphoplasty and vertebroplasty for osteoporotic compression fractures in the spine and in what cases? A large majority of osteoporotic compression fractures can be treated without surgery. Treated conservatively, most of these fractures can heal uneventfully. Occasionally, these fractures can require much longer to heal, and some of them do not heal at all. These are the patients who would benefit from a minimally invasive procedure, such as kyphoplasty or vertebroplasty.
What happens if nothing is done for osteoporotic compression fractures in the spine (best case/worst case scenarios)? In many of these fractures, the bone will heal and the pain will resolve. However, there are patients in whom the bone does not heal in a timely fashion. If left untreated, this can develop into chronic pain. In addition, if numerous compression fractures occur, a kyphotic (hunch back) posture may develop. This hunched over posture is thought to predispose patients to developing additional fractures.What options exist for surgery for osteoporotic compression fractures in the spine? Historically, surgery for osteoporotic compression fractures were extensive. These surgeries included a large incision and exposure, and usually a multilevel fusion for stabilization. In general, such extensive surgeries were poorly tolerated by the elderly population. In addition, the weak osteoporotic bone was not ideal for using instrumentation (screws, rods, hooks) which are often used to provide stabilization in fusion.
Recently, the development of minimally invasive techniques allowed patients with osteoporotic compression fractures to avoid such large extensive surgeries. In general, kyphoplasty and vertebroplasty are performed through two small stab incisions, and the patient usually returns home the day of surgery or the day
When performed by an experienced surgeon, how effective is kyphoplasty and vertebroplasty for osteoporotic compression fractures in the spine likely to be and how long will the benefit last? In the hands of an experienced physician, kyphopalsty and vertebroplasty are extremely effective in relieving pain from osteoporotic fractures. If done correctly, the relief of symptoms from that fracture should last for decades.
Because of the patient’s osteoporosis, the patient is certainly at risk for developing additional fractures elsewhere in the spine, and new symptoms of pain may occur, but in a well performed kyphoplasty or vertebroplasty, pain generally does not re occur at the treated level.
How urgent is kyphoplasty and vertebroplasty for osteoporotic compression fractures in the spine? n osteoporotic compression fractures, there is little urgency for surgical treatment. In fact, many of these fractures are treated without surgery.
Kyphoplasty or Vertebroplasty should be done in patients who have persistent pain, despite a trial of non operative treatment.
What are the most frequent and most serious risks of kyphoplasty and vertebroplasty for osteoporotic compression fractures in the spine? How common are they? The most serious complication of the kyphoplasty or vertebroplasty procedure is from cement leak. At times, because the vertebra is fractured, when cement is injected into the vertebra, cement can leak outside the bone. In the overwhelmingly large majority, these cement leaks do not have a clinical consequence. However, cement can leak into the blood stream and result in an embolism (vessel blockage). Cement can also leak towards the spine and its nerve roots and can potentially damage the spine resulting in neurological injury. Although such cases are extremely rare, they have been reported in the scientific literature and the patient should be aware of these reported complications.
According to recent studies, cement leak appears to be more common in the vertebroplasty procedure than it is in the kyphoplasty procedure. However the larger majority of these leaks did not have any clinical consequence.
There are also risks of bleeding and infection, although these are also very rare.
In addition, if general anesthesia is used for the procedure, the patient carries the risk of general anesthesia in addition to the risk of the surgery.
If risks occur during or after kyphoplasty and vertebroplasty for osteoporotic compression fractures in the spine how are they managed? In the rare event of a complication, measures can be taken to counter them. If cement leakage around the nerves occur, these can be managed in different ways. If there is mild nerve root irritation, steroid injection has been used to treat these patients. If there is evidence suggestive of injury to the spinal cord itself, emergent surgery has been done to remove the cement from around the cord to minimize risks of paralysis.Surgery for Osteoporotic Compression Fractures in the Spine at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 to make an appointment. Our clinical center is located in Seattle Washington, USA
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