Evolution of Technology

Vertebral Kyphoplasty

Balloon kyphoplasty is a minimally invasive procedure used in the USA since 1999 for the treatment of osteoporotic vertebral compression fracture. It is designed to stabilize the fracture and help correct the deformity in the vertebral body. Patients who have disabling intolerable back pain, progressive vertebral collapse, and symptoms that persistent greater than 4-6 weeks may benefit from kyphoplasty.

The procedure is typically done as an outpatient and lasts less than 1 hour. In general, a small (less than 1cm) incision is made and a small opening is made into the fractured bone. A balloon is inserted into the fractured vertebral body. This balloon is carefully inflated to correct the fracture deformity of the collapsed vertebral body. The balloon is then deflated and removed, leaving a small cavity within the vertebral body. This cavity is then filled with bone cement, which stabilizes the fractured vertebrae.

This procedure can help provide some patients with immediate pain relief and has the greatest potential to correct skeletal deformities, compared to standard vertebroplasty, because of its ability to restore vertebral height.

Evolution of Procedure

Vertebral Augmentation Surgery

Vertebral augmentation procedures are the main surgical treatment option for vertebral compression fractures that meet operative indications. The two most commonly used procedures are the vertebroplasty and kyphoplasty. Vertebroplasty, introduced in the U.S. back in the early 1990s, involves injecting cement into a fractured vertebra which can relieve pain, restore vertebral height, and restore spinal mobility.

The procedure is usually done quickly without the need to stay in the hospital overnight. It may be performed with a local anesthetic and intravenous (IV) sedation or general anesthesia. Using x-ray guidance, a small needle containing specially formulated bone cement is injected into the collapsed vertebra. The cement hardens within minutes, strengthening and stabilizing the fractured vertebra. Most experts believe that pain relief is achieved through mechanical support and stability provided by the bone cement. Kyphoplasty is a modification of this technique where a balloon is used to help guide the cement and increase the height of the collapsed bone.

Evolution of Diagnosis

Vertebral Compression Fracture

Vertebral compression fractures occur when the vertebral body of the spine collapses, which can lead to severe pain, deformity, and loss of height. These fractures are particularly seen in elderly patients with osteoporosis (brittle bone) and most commonly occur in the thoracic spine (the middle portion of the spine). Overall, these are the most frequently encountered fractures in the elderly and affect about 750,000 people annually.

People with healthy spines typically suffer a vertebral compression fracture through severe trauma, such as a car accident, sports injury or a hard fall. Usual presenting symptoms include back pain and limited spinal mobility, with possible numbness, weakness, and loss of bowel and bladder control in more severe cases. Imaging studies such as plain radiographs (X-rays), CT scan, and MRI are all potential modalities to assess for injury severity.

Treatments for a compression fracture are mostly nonsurgical in the form of pain medications, activity modification, physical therapy, and bracing. In rare cases, when conservative treatment options have proven ineffective, two minimally invasive procedures, called vertebroplasty and kyphoplasty, may be considered as treatment options. Recent advances in spinal procedures have reduced the need for invasive surgery in many cases.