Anesthesia
- The surgery can be performed in general anesthesia or under local anesthesia + sedation only, thus can avoid the risk of general anesthesia.
Patient position
- Patients are positioned in the prone (lying on the stomach) position, generally using a special operating table with special padding and supports.
Procedure
- During kyphoplasty, a small incision is made in the back and a narrow Jamshedi needle (narrow tube) is inserted into the pedicle to reach the fractured area under the guidance of intra-operative fluoroscopy (X-ray). Followed by, insertion of a special balloon through the tube and into the vertebrae, then gently and carefully inflates it. As the balloon inflates, it elevates the fracture, returning the pieces to a more normal position, and when the balloon is deflated, it leaves behind a cavity inside the vertebrae. With the help of specially designed instruments, the cavity is filled with a cement-like material called polymethylmethacrylate (PMMA), which hardens quickly and stabilizes the bone.
Vertebroplasty is similar to kyphoplasty, except surgery does not involve the use of a balloon, and cement is directed inserted into the fractured vertebra using specially designed instruments.
Post-Operative Care
- After 1-2 hours of monitoring in the recovery room, patients are shifted to ward. Oral fluid intake started after 4 hours and gradually switched to a full diet. Most of the patients experience relief in their back pain and can stand and walk by the evening and can be sent home accordingly on the same day or by the next morning.
Home Care
- To follow proper techniques of getting in and out of bed and walking independently. Should walk and stay active as much as possible. Can climb stairs if required. The patient should avoid prolong sitting (>45-60 min) and avoid bending at the waist, lifting (more than 2-3 kg)
Brace
- Usually not required to wear a back brace after surgery, however, one can wear it if found comfortable and getting some support while standing and walking.
Wound Care and follow up
- Before leaving the hospital, a waterproof dressing is applied to the surgical wound, and the patient can take shower and will be called on the 5th post-op day for a dressing checkup and change of medication if needed.
Return to work
- The patient can resume light work or driving once the pain is tolerable, usually in a week to 10 days. Avoid bending and twisting and no strenuous activity including yard work, housework for the next 2-3 weeks.
Complications
Kyphoplasty and Vertebroplasty are generally considered a very safe procedure, associated with a very low rate of complications, which includes:
General surgical complications:
- Operative wound infection
- Bleeding
- Anesthesia-related complication
- Pain that persists after the surgery
Complications specific to kyphoplasty or vertebroplasty
- Nerve damage or a spinal cord injury from malpositioned instruments placed in the back
- Nerve injury or spinal cord compression from leaking of the cement into the spinal canal
- Allergic reaction to the bone cement or radio-opaque dye solution used to see the balloon on the X-ray image as it inflates
- Risk of cement embolism leading to pulmonary embolism
Advantages and disadvantages: Kyphoplasty vs Vertebroplasty
- The risk of cement leakage is less with kyphoplasty
- Kyphoplasty enables the restoration of loss vertebral height
- However, the kyphoplasty procedure is 5-7 times costlier than vertebroplasty
Result of surgery
- Vertebroplasty and kyphoplasty in most patients produce improvement in the quality of life because of pain relief, marked reduction of the amount of analgesics needed for pain control, and improvement in physical mobility.
