Vertebro- and kyphoplasty

• Osteoporotic vertebral fracture
• Traumatic (accident-related) vertebral body fracture
• Neoplastic vertebral body collapse (vertebral body fracture due to tumor)
• Kyphoplasty
• Vertebroplasty

Synonyms

Vertebral erection, balloon dilatation, cementation of the vertebral body

English: kyphoplasty

definition

Vertebroplasty: Vertebral body stabilization in the case of vertebral body fractures, or prophylactically in the case of impending vertebral body fractures, by introducing bone cement without ballooning the vertebral body.

Kyphoplasty: vertebral body stabilization in the case of vertebral body fractures, or prophylactically in the event of impending vertebral body fractures, by introducing bone cement with balloon erection of the vertebral body.

When can the procedure be used?

Both methods of Vertebral body stabilization (Kyphoplasty and Vertebroplasty) are modern surgical procedures for treating broken-in (sintered) Vertebral bodies in the thoracic and Lumbar spine. It is currently not used on the cervical spine.
In contrast to Vertebroplasty (1987), which was originally developed for the treatment of vertebral body hemangiomas, is the Kyphoplasty (1998) specifically on therapy osteoporotic vertebral fractures has been developed. The majority of patients with osteoporotic vertebral body fractures become symptom-free with adequate pain and physiotherapy. However, 10-20% of patients suffer from chronic Back pain. After excluding other causes, there is an indication for pain-reducing kyphoplasty or vertebroplasty for these patients. Vertebroplasty and kyphoplasty are successfully used for the following diseases:

• Recent osteoporotic vertebral fractures (Spontaneous fractures)
• Recent traumatic vertebral body fractures
• Neoplastic vertebral body incursions (Tumors or metastases)

Appointment with a back specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".
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The spine is difficult to treat. On the one hand it is exposed to high mechanical loads, on the other hand it has great mobility.

The treatment of the spine (e.g. herniated disc, facet syndrome, foramen stenosis, etc.) therefore requires a lot of experience.
I focus on a wide variety of diseases of the spine.
The aim of any treatment is treatment without surgery.

Which therapy achieves the best results in the long term can only be determined after looking at all of the information (Examination, X-ray, ultrasound, MRI, etc.) be assessed.

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Osteoporotic vertebral fracture

Approx. 5 million people in Germany suffer from pathological bone loss (osteoporosis). Vertebral body fractures are one of the most common complications of advanced osteoporosis. Affected suffer from severe acute or chronic back pain, which was mostly conservative with painkillers or earlier Orthotics (Bodice, corset) were treated.
With the kyphoplasty, a successful surgical method is now available, which the structure and Stability of the vertebral body restores and thereby leads to a considerable reduction in pain, and prevents further collapse of the previously damaged vertebral body.
The possibility of kyphoplastic vertebral body treatment, however, in no way replaces systemic osteoporosis therapy!
The place of the most frequent fracture formation is the thoraco-lumbar transition, i.e. the transition of the thoracic spine curvature (Kyphosis) into the lumbar spine curve (Lordosis). Due to the change in curvature of the Spine This creates special stresses on the vertebral bodies, which explain the frequent occurrence of vertebral body fractures in this area.

Traumatic (accident-related) vertebral body fracture

The traumatic vertebral fracture differs significantly from that osteoporotic vertebral fracture. While the osteoporotic vertebral body fractures usually occur spontaneously, gradually or after a minor injury, the traumatic vertebral body fractures are based on a substantial amount of force.
The types of fractures also differ accordingly, with the traumatic vertebral body fractures leading to significantly more complex vertebral body fractures and unequal more frequent serious accompanying injuries such as injury from the Spinal cord, Intervertebral disc or ligament injuries. Complex vertebral body fractures and those with significant accompanying damage cannot be treated with kyphoplasty surgery. In such cases, extensive stabilizing surgical procedures are always necessary.
In general, the Kyphoplasty not yet routinely used in the treatment of traumatic vertebral body fractures. To date, there is too little long-term experience to develop a standard for the use of this procedure in traumatic vertebral body fractures.
The best conceivable form of vertebral body fracture is certainly a fresh, stable compression fracture of a vertebral body without further accompanying injuries. Experience with osteoporotic vertebral body fractures shows that it would be advisable if an operation was performed early, because experience has shown that only then can a satisfactory re-erection of the compressed vertebral body succeed.
Vertebral body fractures with involvement of the Posterior edge of the vertebral body (towards the spinal cord) make a Contraindication for the application of kyphoplasty and vertebroplasty.

Neoplastic vertebral body collapse (vertebral body fracture due to tumor)

The Vertebroplasty was developed to stabilize hemangioma vertebrae (benign vertebral body tumor, based on proliferating vascular growth). Your commitment has proven itself.
The use of kyphoplasty for malignant (malignant) tumors is mainly seen in disseminated (scattered) tumor infestation by osteolytic (bone-dissolving) tumors, when surgical healing in the area of ​​the spine is no longer possible. Authors refer to the theoretically possible venous seeding of malignant vertebral body tumors when the tumor mass is displaced by the balloon catheter.
The major advantage is the relatively small intervention and thus the almost instantaneous possibility to continue an ongoing radiation or chemotherapy.

You can find further information under our topic: Vertebral body fracture

Surgical technique

Two different surgical techniques are used for the Kyphoplasty described, which are mainly in their operative access to the Vertebral bodies distinguish:

The microsurgical "semi-open" technique is used for concomitant diseases that make the operation difficult or for difficult anatomical conditions in the operating area.

A 5 cm long cut is made in general anesthetic operated on. Due to the better intraoperative view, accompanying injuries can also be treated or complications, such as an unwanted leakage of bone cement into the spinal canal, can be remedied immediately. Disadvantages are the greater soft tissue trauma and thus the somewhat longer recovery time for the patient as well as the need for general anesthesia.

In the percutaneous technique, both in general anesthetic, as well as in local anesthesia to be operated on.

All of the surgical steps described below are performed on both sides in chronological order.

Under X-ray control, a hollow needle is inserted into the fractured / broken vertebral body through a stab incision (1-2 cm long skin incision) from the back.

A guide wire is pushed through this hollow needle, which acts as a guide rail for the now inserted working channel.

When placing the working channel, care must be taken to ensure that the vertebral body wall is not injured, as otherwise the later injected bone cement could escape.

A drill is used to create a bearing in the vertebral body for the Kyphoplasty balloon created, then inserted the kyphoplasty balloon. The balloon is gradually filled with contrast medium and the fractured vertebral body is lifted until a satisfactory correction has been achieved. After the vertebral body has been straightened, the balloon is removed. It leaves a bony cavity that joins with viscous bone cement (PMMA = polymethyl methacrylate) is filled under low pressure. The filling volume depends on the last volume of the kyphoplasty balloons (approx. 8-12 ml).

The duration of the operation depends on the number of vertebral bodies operated on. If only one vertebral body has been operated on, the operation time is approx. 30-45 minutes. The patients can be fully mobilized on the day after the operation. The significant pain reduction is usually immediate.

In vertebroplasty, the vertebral body is filled with bone cement without prior balloon erection. Because no bony cavity was created beforehand, the thin-bodied bone cement has to be injected into the vertebral body under high pressure so that it is distributed in it.

Complications

Complications from kyphoplasty are very rare (approx. 0.2% per fracture). The main risk is the leakage of bone cement from the vertebral body, which in comparison is seen more frequently in vertebroplasty (vertebroplasty approx. 20-70%; kyphoplasty approx. 4-10%). The reason for this lies in the use of a more liquid bone cement and a higher pressure generation when the bone cement is injected into the vertebral body during vertebroplasty. This can lead to an escape of bone cement from the damaged vertebral body. Most of the bone cement leakage, however, is not associated with postoperative discomfort for the patient. Overall, however, vertebroplasty is not a very risky surgical procedure. Serious complications are only described in individual cases.

The following complications are described:

• Leakage of bone cement into the spinal canal
• Epidural hematoma (bleeding)
• Bone cement induced pulmonary embolism
• Paradoxical cerebral embolisms
• Fat embolism
• Adjacent vertebral body fractures
• Disruption of the spinal cord when straightening or cementing

Results

For both surgical procedures, kyphoplasty and vertebroplasty, comparably good results with regard to pain reduction are given in the research literature. A significant reduction in pain should be achieved in 80-95% of the cases with both methods.

The cause of the immediate pain reduction lies in the internal stabilization of the vertebral body, which reduces micro-movements that cause irritation of the nerve fibers of the periosteum (periosteum) of the vertebral body.

Please also read our page Healing a fractured vertebra.

Regarding the restoration of the vertebral body height through the kyphoplasty, an average restoration of the measured height loss of approx. 40-50% is shown. However, follow-up examinations showed that there can be a postoperative loss of height of 3-8% within the first 3 months. In addition, the height of the vertebral body remains constant according to current knowledge.

The best results with regard to the restoration of the vertebral body height are observed with fresh fractures (up to 4 weeks), because there has not yet been any osseous union in the deformity

Summary

Kyphoplasty

• Very low-risk surgical procedure
• Indication for older and fresh vertebral body sintering with the aim of straightening the vertebral body.
• Restoration of vertebral body height through a balloon catheter.
• Vertebral body stabilization with bone cement.
• The risk of cement leakage is low because of the previously created cavity and the low filling pressure of the vertebral body with viscous bone cement.
• Rapid, significant pain relief in 80-95% of patients.
• Immediate mobilization possible after the operation.

Vertebroplasty

• Low-risk surgical procedure.
• Indication for certain types of vertebral body tumors and older fractures for stabilization without realigning the vertebral body.
• No restoration of vertebral body height through a balloon catheter.
• Vertebral body stabilization with bone cement.
• High risk of cement leakage due to the introduction of low-viscosity bone cement under high pressure.
• Rapid, significant pain relief in 80-95% of patients.
• Immediate mobilization possible after the operation.