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What is kyphoplasty?

Kyphoplasty and vertebroplasty are similar medical procedures that attempt to stop the pain caused by spinal fractures. These treatments were first introduced in France in 1984 and then came to the U.S. in the 1990’s. Interventional radiologists have been performing image-guided spinal procedures for many years. Kyphoplasty and vertebroplasty is a technique in which a medical-grade cement is injected through a needle into a painful fractured vertebral bone using X-ray guidance. This stabilizes the fracture, allowing most patients to discontinue or significantly decrease narcotic pain medication and resume normal activity.

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Why is it done?

Patients who are unresponsive to conservative therapy of bed rest, analgesics, and back bracing should be considered kyphoplasty. The procedure is performed to help alleviate the pain caused by vertebral (spinal) fractures that can lead to chronic pain, long term decreased activities of daily living, and complications related to prolonged immobility. Vertebral body fractures lead to the collapse or compression of the vertebra causing the spine to shorten and curve forward. This can result in pain and kyphotic (hunched over) deformity. The success rate for this procedure in treating osteoporotic fractures is 75 to 90 percent.

What are the risks?

As with any interventional procedure, there is a small risk of infection and bleeding at the procedure site. Specifically for kyphoplasty the risk is extremely minimal. There is also a small risk of the cement extravasating (leaking) out of the bone, but again this is very rare since the procedure is done under real-time X-ray guidance. Nerve damage is also a very small risk, and usually temporary (lasting a couple of hours) if it does occur.

Reasons to avoid this procedure?

Kyphoplasty should not be a first choice treatment of all back pain problems. You should have proper imaging of your spine (usually an MRI) to assess your fracture and its acuity (is it new?). Kyphoplasty has the highest chance for effectiveness if the fracture is new. There has not been evidence to show that kyphoplasty is effective in old or chronic fractures. To be a good candidate for kyphoplasty, there should be evidence that your pain correlates to the vertebral fracture, and not due to other potential problems such as disk herniation, arthritis, or spinal stenosis (narrowing between vertebral bones).

How do you prepare?

Proper imaging such as spinal x-rays, bone scans, and most importantly magnetic resonance imaging (MRI) should be ordered to confirm the presence of an acute fracture.

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Usually this procedure is performed with IV sedation, local anesthesia, and for some patients general anesthesia is given. You will need to fast for 8 hours before the procedure. We recommend no eating or drinking after midnight before the procedure. Generally, you should take your daily morning medications with a small sip of water.

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Depending on the type of blood thinner you take, you will need to stop that medication before the procedure. Please refer to pre-procedure instructions for detailed instructions about your medications.

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Please leave all valuables such as jewelry, credit cards, and money at home on the day of the procedure. Family members may wish to bring a magazine or book to read during the wait time.

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After checking in at Patient Registration, you will be directed to the Short Stay pre-procedure unit on 2B. Once in the department a nurse will prepare you for the procedure. This preparation will include changing into a gown, a nurse taking your vital signs, starting an IV in your arm, lab tests and giving you IV fluids and IV medications (antibiotics, anti-nausea, etc).

How is the procedure done?

The procedure is performed in the catheterization laboratory, also called “cath lab.” An entire team will be taking care of you during the procedure, which includes two nurses, a radiology technologist and the physician. In the procedure room, a nurse will help you lay on your stomach on the exam table. You will be connected to heart, blood pressure, and oxygen monitors. IV medicine will be given to relax you. Your back area will be shaved and washed with a special soap and covered with sterile sheets. IV medication will be given to make you comfortable (moderate sedation or sometimes general anesthesia).  Then numbing medicine (local anesthesia) is injected into the procedure area. You may feel some burning as the local anesthesia is given. Once it takes effect, the area will be numb. During the procedure, a needle called a trocar is inserted into the bone and an inflatable balloon like device is inserted. This balloon is inflated and not only tries to reshape the compressed vertebra, but also creates a space where the bone cement can be injected. The procedure is all guided by fluoroscopy (X-ray) to ensure exact placement and proper filling of the bone. The cement quickly hardens and forms a support structure within the vertebra that strengthens the bone and hopefully restores some of the original height. The needle is removed and a sterile skin glue is applied at the puncture site.  This seals the procedure site promoting healing and preventing infection. The procedure time varies, but usually takes about 1 hour depending on how many fractures are treated. Throughout the procedure, medication is given through your IV to keep you comfortable. Your oxygen saturation, blood pressure and pulse are checked closely during and after the procedure.

Will I need a catheter to be placed?

In rare cases due to the inflammatory response of the prostate, temporary urinary retention may persist longer than your recovery time. We will have a discussion with you if you would like a Foley catheter placed so you can go home, or wait longer in recovery to see if the retention resolves.

Do I need any medications after the procedure?

You should continue to take your normal medications after the procedure. Although we may be able to taper off the prostate medications eventually, it is important not to stop them suddenly. We usually prescribe an antibiotic for 7 days after the procedure to prevent a urinary tract infection.

How do we measure success after the procedure?

The most important thing is your quality of life. Although only you can tell how satisfied you are, we use a questionnaire called IPSS (International Prostate Symptom Score) to measure the response to the treatment in a more objective way. We will ask you to answer 8 questions before the procedure and after the procedure (1 mo, 3mo and 6mo).

What is the IPSS?

It is an 8 item questionnaire to measure the impact of the prostate symptoms in the quality of life.

  1. Incomplete Emptying: How often have you had the sensation of not emptying your bladder?

  2. Frequency: How often have you had to urinate less than every two hours?

  3. Intermittency: How often have you found you stopped and started again several times when you urinated?

  4. Urgency: How often have you found it difficult to postpone urination?

  5. Weak Stream: How often have you had a weak urinary stream?

  6. Straininga: How often have you had to strain to start urination?

  7. Nocturia: How many times did you typically get up at night to urinate?

  8. If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?

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You can calculate your score using the following website.

https://www.uptodate.com/contents/calculator-international-prostatism-symptom-score-ipss

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The disease is classified based on the score:

Mild: 0-7

Moderate: 8-19

Severe: 20-35

Post-Procedure General Instructions:

Sedation

  • If you received sedation, you should not drive, consume alcohol, operate heavy machinery or make any important decisions for the remainder of the day.

Activity

  • You may resume your regular activities (including driving) after 24 hours, unless you have been restricted for another reason.

  • No exercising, lifting heavy objects or strenuous activity for the next 24 hours.

  • You may shower 24 hours after the procedure.

Pain Management

  • You may use over the counter medication such as Acetaminophen (Tylenol) or Ibuprofen (Advil /Motrin) for minor discomfort, unless you are restricted from taking these medications.

  • If you feel that Tylenol or Advil are not enough to control your pain, please contact the Vascular and Interventional Radiology Clinic at 650-404-8445.

Diet

  • You can resume your normal diet. Some patients may develop nausea after the sedation. Therefore light meals are recommended until you know that you can eat without problems.

  • Make sure you drink enough fluids

Shower

  • You can take a shower tonight. You should not soak the procedure site in water (eg. bath and swimming pool) for 1 week.

When should you call your physician?

Chills or fever > 101 F
Worsening of redness or worsening of pain in the procedure site.
New lower extremity swelling.

You can reach your Interventional radiologist at 650-404-8446

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