Vertebral Augmentation (Balloon Kyphoplasty)
Balloon kyphoplasty is a minimally invasive spinal procedure designed to repair and stabilize vertebral compression fractures. It treats pathological vertebral body fractures due to osteoporosis, cancer invasion, or benign lesions. An inflatable balloon is introduced into a fractured vertebral body under x-ray control and inflated to create a cavity inside of the box shaped vertebral body and to expand the caved-in sides of the vertebral body. It is then filled with a liquid cement that hardens in a short time to create an interior cement cast that stabilizes the re-expanded vertebral body. By stabilizing the fracture, the pain of fracture boney parts resolves. By expanding the caved-in bone, the loss of height and deformity can be corrected. Balloon kyphoplasty is done under local and sedation anesthesia in the office fluoroscopy suite or the hospital outpatient suite.
Candidates for Balloon Kyphoplasty
Patients who have suffered vertebral body fractures from osteoporosis, cancer invasion or an expandingbenign lesion in the 12 weeks prior to having the procedure done and who are having severe pain to the point of incapacity that does not respond to bracing or medication are appropriate candidates; those patients that are past 12 weeks are often far enough along in the healing process that the procedure would not result in symptom relief. Imaging is required to be within 30 days of the procedure and showing an acute fracture. Pain has to be worsening, or there has to be documented progression of vertebral body height collapse, >25% loss of height, kyphotic deformity of spine, severe impact on daily functioning, steroid-induced fracture, or a need to reinforce the broken bone prior to surgery. Painful cancer invasion and some trauma induced fractures are also suitable for balloon kyphoplasty. Unfortunately, not all fractures can be repaired in all situations. PCI providers will carefully assess a patient’s other medical history and condition of the fracture to maintain safety in performance of the procedure.
Balloon Kyphoplasty Procedure
The balloon kyphoplasty procedure is done in the office, outpatient surgery department of the hospital or radiology suite of the hospital. It is generally performed under local anesthesia and mild sedation provided by the anesthetist. The balloon kyphoplasty procedure takes about 1 hour to perform and most return home shortly after completion with full activities and without restrictions allowed after 24 hours. The tools used are disposable and not reused; they are FDA approved for the procedure. The procedure is done through small incisions that are about the size of a baby aspirin in diameter. Pain from the fracture is usually resolved after the procedure with only minor needle related pain that may last a few days.
Risk of Vertebral Balloon Kyphoplasty
Complications from balloon kyphoplasty are low as with most surgical procedures but serious adverse events, some of which can be fatal, can occur including heart attack, cardiac arrest, stroke, and embolism from blood, fat or cement. Other risks include leakage of the cement into muscle and tissue surrounding the spinal cord, blood vessels, and the spinal canal which could cause paralysis. These risks are thoroughly reviewed with all patients to allow an informed decision about doing the procedure for their situation.