What to Expect During a Vertebroplasty or Kyphoplasty Procedure
Image-guided, minimally invasive procedures such as vertebroplasty and kyphoplasty are most often performed by a specially trained interventional radiologist or neuroradiologist.
This procedure is often done on an outpatient basis, but occasionally will require a short hospital stay. Please consult with your doctor.
You will be positioned lying face down for the procedure and will be connected to monitors that track your heart rate, blood pressure and pulse during the procedure.
A nurse or technologist will insert an I.V. into a vein in your hand or arm so that sedative medication can be given intravenously. You also may receive general anesthesia.
You may be given medications to help prevent nausea and pain, and antibiotics to help prevent infection.
The area where the hollow needle (called a trocar) will be inserted will be shaved, sterilized and covered with a surgical drape.
A local anesthetic will be injected into the muscles near the site of the fracture.
A very small nick is made in the skin at the site.
Using X-ray guidance, a hollow needle called a trocar is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra. An examination called intraosseous venography may be performed by some interventional radiologists to make sure the needle has reached a safe spot within the fractured bone. However, many interventional radiologists proceed with vertebroplasty or kyphoplasty directly and skip the intraosseous venography part of the exam.
In vertebroplasty, the orthopedic cement is then injected. Medical-grade cement hardens quickly, typically within 20 minutes.
In kyphoplasty, the balloon tamp is first inserted through the needle and inflated, pushing the bone back to its normal height and shape and creating a hole or cavity. The balloon is then removed and the bone cement is injected into the cavity created by the balloon.
A CT scan may be performed at the end of the procedure to check the distribution of the cement.
The trocar is then removed.
Pressure will be applied to stop any bleeding and the opening in the skin is covered with a bandage. No sutures are needed.
You will remain in the recovery room for an hour following the procedure.
Your I.V. will be removed.
This procedure is usually completed within one hour. It may take longer if more than one vertebra is being treated.
Devices to monitor your heart rate and blood pressure will be attached to your body.
You will feel a slight prick when the needle is inserted into your vein for the I.V. and when the local anesthetic is injected.
If the case is done with sedation, the I.V. sedative will make you feel relaxed and sleepy. You may or may not remain awake, depending on how deeply you are sedated.
The treatment area of your back will be cleaned, shaved and numbed.
During the procedure you will be asked questions. It is important for you to be able to tell your doctor whether you are feeling any pain.
The longest part of vertebroplasty and kyphoplasty procedures involves setting up the equipment and making sure the needle is perfectly positioned in the collapsed vertebra.
You may not drive after the procedure, but you may be driven home if you live close by. Otherwise, an overnight stay at a nearby hotel is advised.
Bed rest is recommended for the first 24 hours following vertebroplasty and kyphoplasty, though you may get up to use the bathroom.
You will be advised to increase your activity gradually and resume all your regular medications. At home, you can return to your normal daily activities, although strenuous exertion, such as heavy lifting, should be avoided for at least six weeks.
Check with your doctor if you take blood thinners. You may be able to restart this medication the day after your procedure.
Pain relief will be immediate for some patients. In others, pain is eliminated or reduced within two days. Pain resulting from the procedure will typically diminish within two weeks.
For two or three days afterward, you may feel a bit sore at the point of the needle insertion. You can use an icepack to relieve any discomfort but be sure to protect your skin from the ice with a cloth and ice the area for only 15 minutes per hour. Your bandage should remain in place for several days (even during showers).
Limitations of Vertebroplasty & Kyphoplasty
Vertebroplasty is not:
- Used for herniated disks or arthritic back pain.
- Generally recommended for otherwise healthy younger patients, mostly because there is limited experience with cement in a vertebral body for longer time periods.
- A preventive treatment to help patients with osteoporosis avoid future fractures. It is used only to repair a known, non-healing compression fracture.
- Used to correct an osteoporosis-induced curvature of the spine, but it may keep the curvature from worsening.
- Ideal for someone with severe emphysema or other lung disease because it may be difficult for such individuals to lie face down for the one to two hours vertebroplasty requires. Special accommodations may be made for patients with these conditions.
- For patients with a healed vertebral fracture.
Kyphoplasty is not appropriate for:
- Patients with young healthy bones or those who have suffered a fractured vertebra in an accident.
- Patients with spinal curvature such as scoliosis or kyphosis that results from causes other than osteoporosis.
- Patients who suffer from spinal stenosis or herniated disk with nerve or spinal cord compression and loss of neurologic function not associated with a VCF.