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Treatments

Kyphoplasty and Sacroplasty

Minimally Invasive Procedures for Vertebral and Sacral Fractures

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Kyphoplasty

A minimally invasive spinal procedure that treats pain due to acute vertebral compression fractures
A compression fracture of the vertebra can occur from trauma, cancer, or most commonly, osteoporosis. Compression fractures are often painful because of instability and swelling of the fractured bone and also because of possible compression of nerve roots exiting the spinal cord. In fact, fractures of the vertebra form a wedge-like profile and can lead to the abnormal forward curvature of the spine known as kyphosis. Kyphosis, when severe can restrict lung capacity and prevent deep breathing. Kyphoplasty seeks to rebuild some of the compressed vertebra and restore stability to the spine, resulting in significant decease in back pain.

Procedure Kyphoplasty

Kyphoplasty is a minimally invasive spinal procedure that treats pain due to acute vertebral compression fractures. A compression fracture of the vertebra can occur from trauma, cancer, or most commonly, osteoporosis. Compression fractures are often painful because of instability and swelling of the fractured bone and also because of possible compression of nerve roots exiting the spinal cord. In fact, fractures of the vertebra form a wedge-like profile and can lead to the abnormal forward curvature of the spine known as kyphosis. Kyphosis, when severe can restrict lung capacity and prevent deep breathing. Kyphoplasty seeks to rebuild some of the compressed vertebra and restore stability to the spine, resulting in significant decease in back pain.

treatment of back pain due to an acute fracture in the sacrum

Sacroplasty is indicated for the treatment of back pain due to an acute fracture in the sacrum that is so painful that activities of daily living are difficult to do despite conservative measures such as pain medications and /or back bracing. On physical examination, there is often pain to palpation over the sacrum and pain with standing or sitting. An MRI is helpful in detecting fluid in the vertebra indicating that the fracture is recent and therefore likely to improve with kyphoplasty. If an MRI can not be done due to presence of a pacemaker or other reasons, a CT scan followed by a bone scan can help determine that a fracture is new. Fractures in the sacrum that can be treated with sacroplasty should not involve a fracture that extends into the holes (foramen) where the sacral nerves travel.

Procedure

Sacroplasty, like kyphoplasty, can be performed in a same day surgical center or operating room under deep sedation or general anesthesia to assure comfort. Local anesthesia is also used to help alleviate pain during the procedure. A small incision will be made over the vertebra or vertebrae that requires attention. A small probe is then placed inside the incision, and special moving x-rays, called fluoroscopy, help the doctor guide the probe into the sacrum.
While no balloon is inflated, the cement like substance, polymethylmethacrylate, is injected to fill the sacral fractures from the top to the bottom of the sacrum on each side as needed. The cement hardens within a few minutes to stabilize the spine. Once the material hardens, the equipment is removed, and the small, puncture like incision is closed.

 
 

Recovery and Relief

You will be taken to recovery and watched closely for a few hours following the procedure. Most patients will be able to return home the same day, but in some cases, the doctor may want you to stay in the hospital overnight for further observation, related to the anesthesia. Most patients feel relief from their back pain immediately, but for some it may take a few days, depending on the nerve involvement. You should be able to move better than before and with less pain. You will not be able to drive for a few days after the kyphoplasty or sacroplasty because of the anesthesia, so it is important to arrange transportation to and from the hospital and doctor’s visits.

Most patients can return to normal activities within one to two days, but you should not lift heavy object for at least six weeks. In general, kyphoplasty or sacroplasty are safe procedures. The possible risks include bleeding, infection, reactions to the anesthesia, leakage of the cement into the surrounding tissues or cement travelling through blood vessels to the lungs. However, these complications are rare, and most patients experience a dramatic increase in their quality of life following kyphoplasty or sacroplasty.