The doctor will use a fluoroscope to guide their needle to the fractured vertebra. Then, they will insert the bone cement directly into the fracture. The cement quickly hardens, binding the fraction fragments into place and providing stability to the vertebrae. A vertebroplasty provides immediate stability to the area without attempting to manipulate the vertebra into place. This means that it is somewhat less effective when dealing with fractures that have caused severe collapse in the vertebra or spinal deformities.
Fortunately, this is where kyphoplasty procedures come in. An important comparison between vertebroplasty and kyphoplasty, however, is that kyphoplasty procedures first use a balloon catheter to create a cavity in the bone. This space helps fix a collapse in the vertebra, correct wedging from the fracture, and restore normal spinal alignment. You should avoid drinking juice, cream and milk.
Follow your doctor's instructions. In most cases, you should take your usual medications, especially blood pressure medications.
Take these with sips of water on the morning of your procedure. Other than medications, your doctor may tell you to not eat or drink anything for several hours before your procedure.
For vertebroplasty and kyphoplasty procedures, x-ray equipment, a hollow needle or tube called a trocar , orthopedic cement , and a cement delivery device are used. For kyphoplasty, a device called a balloon tamp is also used to make room for the balloon catheter.
Compact, portable x-ray machines can be taken to the patient in a hospital bed or the emergency room. The x-ray tube is connected to a flexible arm.
The technologist extends the arm over the patient and places an x-ray film holder or image recording plate under the patient. The orthopedic cement includes an ingredient called polymethylmethacrylate PMMA.
Its physical appearance resembles toothpaste, which hardens soon after placement in the body. This procedure may use other equipment, including an intravenous line IV , ultrasound machine and devices that monitor your heart beat and blood pressure.
When a vertebra breaks or fractures, bone fragments develop. Pain occurs when these fragments slide or rub against each other or protrude into the spinal cord. Vertebroplasty involves injecting the bone with a cement mixture to fuse the fragments, strengthen the vertebra and provide pain relief. First, the skin is numbed with a local anesthetic. Then, using imaging guidance, the hollow needle or trocar is passed through the skin into the vertebral body for injection of the cement mixture into the vertebra.
In kyphoplasty, after numbing the skin locally, a balloon is inserted through the trocar into the fractured vertebra where it is inflated to create a cavity for cement injection.
The balloon is removed prior to injecting cement into the cavity that was created by the balloon. Image-guided, minimally invasive procedures such as vertebroplasty and kyphoplasty are most often performed by a specially trained interventional radiologist or neuroradiologist in an interventional radiology or neuroradiology suite, or occasionally in the operating room.
This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Ask your doctor if you will need to be admitted. The doctor or nurse may connect you to monitors that track your heart rate, blood pressure, oxygen level, and pulse. A nurse or technologist will insert an intravenous IV line into a vein in your hand or arm to administer a sedative. This procedure may use moderate sedation. It does not require a breathing tube.
However, some patients may require general anesthesia. Your doctor may provide medications to help prevent nausea and pain and antibiotics to help prevent infection. The area through which the hollow needle, or trocar, will be inserted will be shaved, sterilized with a cleaning solution and covered with a surgical drape. A local anesthetic is then injected into the skin and deep tissues, near the fracture. Using x-ray guidance, the trocar is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra.
In vertebroplasty, the orthopedic cement is then injected. Medical-grade cement hardens quickly, typically within 20 minutes. The trocar is removed after the cement is injected. In kyphoplasty, the balloon tamp is first inserted through the needle and the balloon is inflated, to create a hole or cavity. The balloon is then removed and the bone cement is injected into the cavity created by the balloon.
The doctor applies pressure to prevent any bleeding and covers the opening in the skin with a bandage. No sutures are necessary. This procedure is usually completed within one hour.
It may take longer if more than one vertebral body level is being treated. The doctor or nurse will attach devices to your body to monitor your heart rate and blood pressure. You will feel a slight pinch when the nurse inserts the needle into your vein for the IV line and when they inject the local anesthetic.
Most of the sensation is at the skin incision site. The doctor will numb this area using local anesthetic. You may feel pressure when the doctor inserts the catheter into the vein or artery. However, you will not feel serious discomfort. If the procedure uses sedation, you will feel relaxed, sleepy, and comfortable. You may or may not remain awake, depending on how deeply you are sedated.
During the procedure you will be asked questions related to your comfort. The needle is then removed and the cement hardens within 10 minutes. The bone begins to stabilize and the puncture is covered with a bandage. After the procedure, our team will monitor the patient to ensure medication has worn off and that the bone cement has hardened without complication.
Following the procedure, we recommend patients to take it easy. Some soreness is normal which can be relieved with an ice pack. We recommend increasing activity levels gradually and return to strenuous physical activity after 6 weeks. You will be invited to a follow-up appointment with Dr. Landrum to ensure recovery is going well. Similar to vertebroplasty, a kyphoplasty is a minimally invasive procedure that is designed to stop the pain with a spinal fracture. The procedure begins with making a small incision in the back.
A tube is then inserted into and guided into the correct position.
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