Kyphoplasty and Vertebroplasty
While these two procedures are not within the range of those done by our Pain Consultants, they may sometimes be appropriate for patients we see, and so some details are included here.
In certain conditions the vertebrae in the spine may develop compression fractures. These are due to the normal square vertebral body becoming squashed inwards, often to become wedge-shaped. This may occur in a number of conditions, commonly due to osteoporosis but sometimes other conditions such as myeloma.
This may lead to pain in the affected area. In some affected patients it may be helpful to reinforce the collapsed vertebra by injection of the same sort of bone cement into it as is used to fix hip and other joint replacements. This can be done by straightforward injection into the vertebral body by a tube inserted into it (vertebroplasty) or by initially putting a high-pressure balloon through the tube to squeeze the vertebral body outwards before injecting the cement (kyphoplasty).
The National Institute for Clinical Excellence (NICE) have released advice on kyphoplasty, and linked with this is a patient information document which is linked here, and which may be helpful. Some of the text from this is reporoduced here:
Osteoporotic fractures are unexpected breaks or cracks in weakened bones, and are common in older people. These fractures often happen in the bones (vertebrae) that make up the backbone or spine.
Osteoporotic fractures in the backbone cause the vertebrae to collapse – they are known as vertebral compression fractures. Osteoporotic fractures are especially likely in women after their periods have stopped completely (postmenopausal women). They can also happen in other people such as those who have taken drugs called steroids for a long time. Osteoporotic fractures in the backbone can happen for other reasons such as tumours affecting the backbone and a type of non-cancerous growth called a haemangioma.
Fractures in the backbone often cause pain. They also sometimes make the spine gradually change shape and become abnormally curved or ‘hunched’ (known as kyphosis). These changes in shape may cause more fractures in nearby vertebrae leading to more changes in shape and more pain. People affected usually lose some height. They are also more likely to have falls as the problem gets worse.
Standard treatments for people with vertebral compression fractures are pain killers (analgesics) and back supports. Most people do not have pain or other problems after they have this treatment and do not need an operation.
For some patients the standard treatments do not work – more vertebrae may collapse, and they may have severe pain. These patients may be helped by treatments that do not need a major operation. Two of these new treatments (kyphoplasty and vertebroplasty) are ways of strengthening with cement the bone that has collapsed.
For balloon kyphoplasty a small opening is made in the patient’s back. A small channel is drilled into the spine and one or two special balloons (inflatable bone tamps) are placed into the bone (vertebra) that has collapsed.
A special X-ray method (fluoroscopy) is used to see what is happening during the procedure. The balloons are filled with a substance (radiopaque contrast medium) that makes them show up on the X-ray. The balloon is blown up slowly until the vertebra is back to as near its normal height as possible. The balloon is then let down and removed. The space left in the vertebra is then filled with special cement to strengthen the bone. More than one part of the spine can be treated in one session.
A good video on Kyphoplasty (and some further information) can be found at the Spine-Health website.
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Pain Service Website, Gloucestershire Hospitals NHS Foundation Trust
Webmaster Dr J G de Courcy, Consultant in Pain Medicine and Anaesthesia
Page updated 19/02/2016