Spinal Surgery for Fractured Vertebrae
In older people with soft or brittle bones (osteoporosis), the bones of the spine (vertebrae) sometimes fracture or collapse. This causes pain and a “hunchback” appearance that get worse as time goes on. Certain forms of cancer also weaken the vertebrae and cause the same problems. A relatively new treatment for these conditions is a type of spinal surgery called “kyphoplasty” (ki’-fo-plass-tee).
What is the Surgical Procedure?
Kyphoplasty requires only two small incisions in the back. You can usually go home the same day. You may receive a general anaesthetic. This means that you will be completely unaware of what’s going on. Or you may have an intravenous local anaesthetic. This numbs only the area of the surgery. Your surgeon or the anesthesiologist will discuss which is best for your case.
The surgery is performed on your back. You will lie face down on the operating table. The surgeon will make two small cuts, insert tubes through the openings, and then push tiny balloons through the tubes into the fractured vertebrae. The surgeon uses an X-ray machine to track the progress of the balloons.
When the balloons are in place, they are gently inflated. This pushes the bones back toward their normal height and shape. Pushing the vertebrae up leaves cavities within the bones. After removing the balloons, the surgeon use bone cement to fill the cavities. The tubes are removed as soon as the cement has hardened. This takes about 15 minutes. The incisions are so small that the surgeon will close them with a single stitch.
After kyphoplasty, you will not have any restrictions on what you can do. Your physician will encourage you to resume all your normal activities as soon as possible.
What Results Can I expect After Kyphoplasty?
Early results on other patients have shown that kyphoplasty is a safe and effective method of reconstructing and stabilizing collapsed vertebrae in the spine resulting from osteoporosis or cancerous tumors. Most patients have excellent pain relief and straighter backs. This may result in added height. More than 95 percent of patients rate their treatment as successful and report that they are able to return to all their pre-fracture activities. Most patients do not need physical therapy or any other form of rehabilitation. They should take bone-strengthening medication during treatment.
A few patients complain of persistent pain after kyphoplasty. Sometimes the area is painful because the tissues have been irritated by the procedure. If this is the case, the pain should get better within two weeks. Other patients may have underlying degenerative arthritis in the spine. With these patients, the usual treatment is medication and an ongoing exercise program. If you have persistent pain after kyphoplasty, talk to your doctor about what can be done to relieve it.
For the best results, kyphoplasty should be performed as soon as possible after spinal bone collapse or fracture. The results are less predictable in older fractures but in certain circumstances may still be beneficial.
If you have severe osteoporosis, spinal bones that were not treated could collapse or fracture at other levels of the spine. If this happens, you can have another kyphoplasty to treat these bones. However, kyphoplasty tends to help prevent further fractures by keeping the spine aligned in its proper upright position.
Who Should Not Have Kyphoplasty?
- Kyphoplasty is recommended for older patients with vertebral collapse or fracture due to osteoporosis or tumor only. It is not suitable for:
- Patients with young, healthy bone
- Young patients whose fractures or collapse of the vertebrae are due to high-energy accidents or injury
- Patients with spinal curvature, such as scoliosis or kyphosis, due to causes other than osteoporosis
- Patients with spinal stenosis or herniated discs with nerve or spinal cord compression and loss of neurological function
The use of anesthetics carries some risks in all surgeries. The risks depend on your overall health.
There is a slight possibility that bone cement will leak outside the vertebrae. This happens in less than 10 percent of patients. In most cases, it does not cause any problems. Very rarely, the cement may irritate or damage the spinal cord or nerves. This can cause pain and/or altered sensation. The risk of paralysis as a result of leaking cement is estimated to be less than one case in 10,000 cases. Though it is seldom required, surgery could be necessary to remove any cement that has leaked.
There is also an extremely small chance that cement could travel to the lungs and an even smaller chance that the cement block could cause infection at the time of surgery or even years after surgery. These complications would be treated with medications and/or surgery.