Background Information:

What are the other Names for the Procedure?

• Balloon Kyphoplasty
• Kyphoplasty and Vertebroplasty
• Treatment of Vertebral Compression Fractures

What is Vertebroplasty and Kyphoplasty radiology procedure? (General Explanation)

• Vertebroplasty and Kyphoplasty are minimally invasive procedures used in the treatment of vertebral compression fractures
• Vertebral compression fractures are caused by various conditions such as osteoporosis, metabolic disorder, trauma, or cancer
• Vertebroplasty procedure involves using fluoroscopy to inject cement (a special chemical) into the fractured vertebrae
• Kyphoplasty involves inserting a balloon in a fractured vertebrae and creating space to inject cement into that space

What part of the Body does the Procedure involve?

Vertebroplasty and Kyphoplasty procedures involve the vertebrae of the spine in the back.

Why is the Procedure Vertebroplasty and Kyphoplasty radiology procedure Performed?

• Vertebroplasty and Kyphoplasty procedures are performed to treat vertebral compression fractures
• In order for these procedures to be successful, they should be completed within eight weeks of the acute fracture
• It is usually performed after less invasive methods, such as bed rest, pain medications, and back braces, have failed

Vertebral compression fractures involve collapse of one or more vertebrae in the spine, which leads to severe pain and restriction in movement. These fractures may be caused by conditions that affect the spine such as osteoporosis, cancers, metabolic disorders, or trauma/injury

What is the Equipment used? (Description of Equipment)

The following equipment is used during the Vertebroplasty and Kyphoplasty procedures:

• Fluoroscopy:
  • Fluoroscopy uses X-ray technology
  • The procedure involves an examination table, X-ray tube, and a television-like monitor
  • It converts X-rays into video images, which can be seen in real-time while the procedure is ongoing
• Orthopedic cement:
  • It looks like toothpaste and is soft
  • The cement hardens after it is placed in the fractured vertebrae
• Cement delivery device:
  • This is a plastic device used for mixing the cement and delivering it to the fractured vertebrae

What are the Recent Advances in the Procedure?

There have been no recent advances in the Vertebroplasty and Kyphoplasty procedure.

What is the Cost of performing the Vertebroplasty and Kyphoplasty radiology procedure?

The cost of Vertebroplasty and Kyphoplasty procedures depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Vertebroplasty and Kyphoplasty procedures and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/25720730 (assessed on 3/5/15)

http://www.ncbi.nlm.nih.gov/pubmed/25570007 (assessed on 3/5/15)

http://www.ncbi.nlm.nih.gov/pubmed/25558323 (assessed on 3/5/15)

Prior to Vertebroplasty and Kyphoplasty radiology procedure:

How does the Vertebroplasty and Kyphoplasty radiology procedure work?

• Vertebral fractures cause severe pain as the broken fragments rub against each other
• The cement used for the Vertebroplasty and Kyphoplasty procedures help to fuse the fragments and also strengthen the vertebrae
• Since vertebrae are strengthened and fragments are fused, there is relief from pain and patients are able to walk normally

How is the Vertebroplasty and Kyphoplasty radiology procedure Performed?

The Vertebroplasty and Kyphoplasty procedures are performed in the following manner:

• The patient is positioned face down on the examination table in the prone position
• The vital signs are monitored using various monitors
• An IV line is inserted into the patient’s arm vein to give sedation
• Area of needle insertion is cleaned, shaved, sterilized, and surgically draped; the needle insertion area is numbed using a local anesthetic
• A small skin incision is made at the needle insertion site
• Using fluoroscopy, trocar is inserted through the skin incision and passed to the muscles
• The trocar is carefully advanced so that its tip is positioned in the fractured vertebrae
• Orthopedic cement is injected through the trocar, which hardens in about 20-30 minutes
• In kyphoplasty, a balloon is inserted to the needle, and it is inflated to create a cavity. Once the cavity is created, the balloon is removed and the cement is injected into the cavity
• After the procedure is complete, the trocar is removed
• Pressure is applied to prevent any bleeding; no sutures are necessary, as the skin incision made is very small

Where is the Procedure Performed?

Vertebroplasty and Kyphoplasty surgical procedures are performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

An interventional radiologist, a pain management specialist, or a neurosurgeon performs the Vertebroplasty and Kyphoplasty surgical procedures.

How long will the Procedure take?

• The Vertebroplasty and Kyphoplasty procedures may take about 30-60 minutes to complete
• It may take longer, if more than one vertebra fractures are treated

Who interprets the Result?

The interventional radiologist, pain management specialist, or neurosurgeon interprets the results of the procedure.

What Preparations are needed, prior to the Procedure?

Following preparations are needed prior to Vertebroplasty and Kyphoplasty procedure.

• Several blood tests, spine x-rays, bone scan, or MRI scans may be performed before this procedure to evaluate the compression fracture(s)
• Patients should inform their physicians about their medical conditions, medications, and any over the counter medications, or herbal supplements that they are taking
• Patient should inform their physician if they are allergic to any medications, especially to local anesthetic medications, contrast material, and anesthesia
• Patients may be asked not to eat or drink anything for several hours before the procedure
• Patient may take the regular medications with a sip of water up to six hours before the procedure
• Blood thinning medications, such as NSAIDs, aspirin, heparin, and warfarin, may have to be avoided to prevent any excess bleeding during the procedure
• Women should inform their physician if they are pregnant or if there is a chance that they might be pregnant, to avoid excessive radiation to the fetus

What is the Consent Process before the Procedure?

A physician will request your consent for the Vertebroplasty and Kyphoplasty procedures using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent. 

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of the Vertebroplasty and Kyphoplasty procedures:

• It is a minimally-invasive procedure and has less complications and risks compared to surgical procedure
• It is very effective in relieving patient’s pain due to vertebral compression fracture
• The results from these procedures are immediate
• Only a small skin incision is needed to perform this procedure
• These procedures are very safe and effective

Following are the risks of the Vertebroplasty and Kyphoplasty procedures:

• In extremely rare cases, orthopedic cement may leak out and cause severe problems, if it comes in contact with the spinal canal or blood vessels
• Since skin is penetrated during the procedure, there is a minimal risk of infection after the procedure
• During the procedure, there is a very minimal risk of damaging the spinal cord
• In a small number of patients, additional compression fractures may occur after these procedures. These patients may initially find temporary relief, but then may develop pain a few days after the procedure

What are the Limitations of the Vertebroplasty and Kyphoplasty radiology procedure Procedure?

Following are the limitations of the Vertebroplasty and Kyphoplasty procedures:

• This procedure is not recommended in patients with spinal stenosis
• It cannot be performed in patients with herniated disc, with or without spinal cord compression
• This procedure is also not recommended for patients with scoliosis or kyphosis, which are conditions that cause abnormal curvature of the spine
• This procedure is not performed as a preventive measure for osteoporosis to avoid fractures. It can be only performed after the fracture
• It cannot be used for back pain caused by arthritis
• It is not preferred in young patients, as research data is not sufficient for using cement for longer period of time. Also, younger patient tend to heal and recover faster than the older patients with osteoporosis
• These procedures are harder to perform in patients with lung problems, such as severe emphysema, as it is hard for these patients to lie down on their face

This procedure is only useful in acute fractures and should be done within eight weeks of the fracture. It should not be performed in chronic vertebral fractures.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What are Vertebroplasty and Kyphoplasty procedures?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Vertebroplasty and Kyphoplasty radiology procedure:

What is to be expected during the Vertebroplasty and Kyphoplasty radiology procedure?

The following may be expected during the Vertebroplasty and Kyphoplasty procedures:

• The patient may feel a slight pinprick when the IV line is inserted into the patient’s arm vein and at the needle insertion site in the back, when it is numbed using a local anesthetic
• If sedation is used during the procedure, patient may feel sleepy and relaxed and may not remember most of the procedure
• The patients will be asked questions such as if they have any pain in their back, and if it is radiating to any other part of the body, etc.
• Patients have to remain still throughout the procedure, which may cause some discomfort in them
• Patient may feel a tapping sensation when the trocar is introduced into the bone
• They may also feel a slight pressure during the procedure
• After the procedure is complete, the trocar is removed and pressure applied to the insertion point, to avoid any bleeding

What kind of Anesthesia is given, during the Procedure?

A local anesthetic and moderate sedation can be used during the Vertebroplasty and Kyphoplasty procedures.

How much Blood will you lose, during the Procedure?

Since Vertebroplasty and Kyphoplasty are minimally-invasive procedures, the blood loss involved during the procedures is minimal.

What are the possible Risks and Complications during the Vertebroplasty and Kyphoplasty radiology procedure?

• In extremely rare cases, orthopedic cement may leak out during Vertebroplasty and Kyphoplasty procedures and may cause serious problems, if it ends up in the spinal canal or the blood vessels
• Since skin is penetrated during the procedure, there is a risk of infection after the procedure, even though the risk is very minimal
• There is a very minimal risk of spinal cord damage during the procedure

What Post-Operative Care is needed at the Healthcare Facility after the Vertebroplasty and Kyphoplasty radiology procedure?

No specific post-operative care is needed at the healthcare facility after the Vertebroplasty and Kyphoplasty surgical procedures.

After the Vertebroplasty and Kyphoplasty radiology procedure:

What is to be expected after the Vertebroplasty and Kyphoplasty radiology procedure?

• After Vertebroplasty and Kyphoplasty are complete, patients have to wait in the recovery room until the cement hardens, which takes about 30 minutes
• Relief from pain may be felt immediately after the procedure. In some patients, it may take a few days for the pain to subside or go away
• Patients are advised to bring a family member or friend to drive them back home
• There may be a sore back for a few days after the procedure, due to the needle insertion. Ice packs may be used to reduce the soreness
• Bandage applied on the back should remain in place for about 2 days; wetness on the area should be avoided

When do you need to call your Physician?

Patients may need to call their physician in the following situations after the Vertebroplasty and Kyphoplasty procedures:

• If there is any signs of infection, such as redness, tenderness, warmth, and swelling at the site of needle insertion
• If patients develop high fever
• If the pain does not go away completely or recurs within a few days
• If any numbness, tingling sensation, or breathing difficulties are experienced after the procedure

What Post-Operative Care is needed at Home after the Vertebroplasty and Kyphoplasty radiology procedure?

• Heavy lifting or strenuous physical activities must be avoided for six weeks after the procedure
• One’s regular activities must be gradually increased to avoid any pain to the area

How long does it normally take to fully recover, from the Procedure?

• Most patients sense immediate pain relief after Vertebroplasty and Kyphoplasty; they also gain their lost mobility
• Orthopedic cement only takes about 30 minutes to harden. After that, the patients are able to resume their normal activities in a limited manner (under advise of the physician)
• It takes about six weeks to fully recover from the procedure

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Vertebroplasty and Kyphoplasty procedures do not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Vertebroplasty and Kyphoplasty radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Vertebroplasty and Kyphoplasty procedures are performed.