Multi-Specialty Case Reviews: Kyphoplasty

Mr. WW’s Kyphoplasty procedure

Mr. WW had an extensive history of medical problems, including high blood pressure, severe coronary artery (heart) disease and a seizure disorder, so he was felt to be at high risk for general anesthesia and thus local anesthesia was employed during the kyphoplasty procedure as the sole pain-numbing agent.

Here is a summary of the kyphoplasty procedure the patient underwent to treat the vertebral compression fracture that was causing his mid back pain. Most kyphoplasty procedures like this one take between 30 and 45 minutes to complete.

Setup for kyphoplasty

Mr. WW walked into the operating room and climbed onto the Jackson frame operating table (which allows surgeons to operate from both the front and the back of the body in one surgery). He lay down, face-first, onto the well padded table.
Operative drapes were placed over his back once his skin was scrubbed with antiseptic cleansers. His skin was numbed with Lidocaine (a drug similar to Novocain used by dentists).
A needle was advanced to the T-11 level of his spine under fluoroscopic guidance, which helps the physician see where the needle goes. This area was anesthetized with Lidocaine as well.
When asked by the surgeon, Mr. WW said he was comfortable.

The kyphoplasty procedure

A cannula (small tube) was advanced down Mr. WW’s pedicle (part of the bone in the spine that serves as an avenue to the region where the spine fracture is) and a sample of bone was collected and sent to pathology as a biopsy specimen. Biopsies are helpful in diagnosing conditions other than osteoporosis that can cause vertebral compression fractures (particularly tumors).
A second cannula was then placed in position in the other T-11 pedicle in a similar fashion.
Once the cannulas were in position on fluoroscopy (x-ray guidance), the vertebral body was numbed with Lidocaine.
Balloons were then inserted through the cannulas and used to create a cavity in the vertebral body for 1) placement of the bone cement and 2) to restore height to Mr. WW’s T-11 vertebral body (Figure 3).

The balloons were removed and bone cement was placed into the cavity created by the balloons under low pressure (Figure 4).
Fluoroscopy was used to monitor for any possible extrusion of the cement beyond the anatomic boundary of the vertebral body.
The cannulas were removed and the small wounds were irrigated, sewn closed with two stitches, and a sterile dressing applied.

Mr. WW then moved himself over onto the awaiting gurney and was wheeled into the recovery room where he reported “my pain is gone”.

Final radiographs demonstrated partial restoration of vertebral height and no extrusion of bone cement into the vertebral canal (Figure 5).

Pain relief after kyphoplasty is usually fairly rapid
At his follow up appointments after the kyphoplasty surgery, the patient continued to report full resolution of his mid back pain and resumption of his pre-fracture level of activity.

While not all patients with a spine fracture from osteoporosis experience immediate pain relief following kyphoplasty, many report significant pain reduction within days of the procedure. Most patients can return to a normal level of activity right away, but should refrain from overly strenuous tasks (e.g., heavy lifting) for about six weeks following the kyphoplasty procedure.

It is important to note that Kyphoplasty does not reduce the chances of the patient sustaining a fracture to another vertebral body. For this reason, the patient’s treatment plan should include treating the osteoporosis with the goal of minimizing chances of sustaining another painful fracture.

By: Andrew P. Manista, MD and A. Jay Khanna, MD
December 30, 2005