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Introduction
Procedure
Risks
Alternative Treatments
The lumbar spine is comprised of vertebral bodies (also known as vertebrae) that are separated by soft intervertebral discs, which act to cushion the spine, allow mobility, and provide stability.
In individuals with osteoporosis or tumor that involves the spine, the bones of the spine become less dense and more brittle. As a result, even with relatively minor force or trauma, the vertebrae may collapse within themselves and become compressed -- creating a vertebral compression fracture. These fractures often occur in the middle (thoracic) and lower (lumbar) parts of the spine and are generally accompanied by significant pain.
In select patients a minor surgical procedure may be the best option for relief of pain and prevention of loss of function and mobility. This operation involves the injection of a cement/glue material directly into the fractured vertebra through the skin in order to stabilize the fracture and reduce pain. Two versions of this procedure are currently available -- kyphoplasty and vertebroplasty -- with minor differences between them, which are explained below.
Kyphoplasty
After induction of general anesthesia, X-rays are used to localize the fractured vertebra.
A thin and hollow metal tube is then placed through a small puncture wound in the skin and into the fractured vertebra under X-ray guidance. The tube will act as a conduit through which various instruments will be passed into the vertebra.
A catheter, with a balloon at the tip, is then placed through the metal tube and into the body of the fracture.
The balloon is then inflated in order to create a cavity within the vertebral body for the cement/glue and in order to restore some height to the fractured vertebral body.
The balloon is then deflated and removed, leaving a cavity in the bone and the metal tube.
A catheter is then placed inside of the cavity (through the hollow metal tube) and the cement/glue is delivered into the cavity under X-ray guidance.
Once the cavity is full, the catheter and the hollow tube are removed and the small puncture wound in the skin is closed.
Vertebroplasty
The vertebroplasty procedure is very similar to the kyphoplasty, with the exception that after the hollow metal tube (conduit) has been placed into the vertebral body, a balloon is not used to create a cavity in the bone.
Instead, the cement/glue is delivered directly into the fractured bone under some pressure. This will cause the cement to seep into the spaces between the pieces of the fracture and glues them together.
The remainder of the vertebroplasty procedure is similar to the kyphoplasty operation.
Due to advances in medicine and technology, surgical procedures are generally considered to be safe, and a great majority of patients who undergo surgery will not experience any complications. However, there are certain risks involved in any procedure which are important to be aware of in order to make an informed treatment decision.
Risks Specific to this Procedure: The risks associated with this surgery include, but are not limited to, damage to spinal cord or nerve roots by leakage of cement during surgery leading to increased pain or other neurologic problems, loss of bowel/bladder function, sexual dysfunction, weakness or paralysis, numbness, cerebrospinal fluid leakage requiring placement of lumbar drain, need for further surgery. There is also a risk of damage to any of the organs in the abdomen such as the bowel, nerves, and/or blood vessels leading to a variety of potential problems.
Infection: Invasion of tissue by bacteria or other germs occurs to some degree whenever a cut, incision or puncture is made. In most instances, through the natural defense mechanisms of the body, healing of the affected area occurs without difficulty. In some instances antibiotic medicines are prescribed and at times additional surgical measures may be necessary to combat infection.
Hemorrhage: The cutting of blood vessels causes bleeding and this occurs in every surgical incision. This bleeding is usually controlled without difficulty. At times, blood transfusions are required to replace blood loss. If blood transfusions are given, there are additional risks of liver inflammation, hepatitis, and the possibility of receiving Acquired Immune Deficiency Syndrome (AIDS). There is no absolutely reliable way to predict these unwanted reactions, some of which may be quite serious and even lead to death.
Drug Reactions: Unexpected allergies, lack of proper response to medications or illness caused by the prescribed drugs are possibilities. It is important for you to inform your physician and your anesthesiologist or certified registered nurse anesthetist of any problem you or your family have had with reactions to drugs and which medications you have taken in the past six months, including over-the-counter drugs, especially aspirin.
Anesthesia Reactions: There may be unusual or unexpected responses to the gases, drugs or methods used to anesthetize you which can lead to difficulties with lung, heart or nerve function. Eating or drinking before anesthesia increases the risks of vomiting which may cause significant complications. Inform your anesthesiologist or certified registered nurse anesthetist of problems you and your family have had with anesthesia.
Blood Vessel Inflammation and Clotting: It is impossible to predict the occurrence of blood vessel inflammation and clotting problems. If blood clots form, they can move from where they formed to other areas of the body and cause injury.
Injury to Other Organs: Because of the closeness of other organs to the area being operated on, there may be injury to other organs. The stress of surgery or the procedure may also harm other organ systems of the body.
The alternative management modalities for this procedure are physical therapy, pain management using medications or injections, certain alternative medicine therapies (acupuncture), and expectant management with no treatment at all. If the decision is made to not have this procedure, there may be associated risks which need to be discussed with a physician.
