Kyphoplasty

Original Editor - Margaret Chislett

Top Contributors - Margaret Chislett  

Description

Kyphoplasty is a newer percutaneous procedure that addresses the kyphotic deformity as well as the fracture pain (versus vertebroplasty which does not address the kyphotic deformity). Kyphoplasty involves the percutaneous insertion of an inflatable bone tamp into the fractured vertebral body under fluoroscopic guidance. The bone tamp is then inflated, elevating the endplates and restoring the vertebral body toward its original height. Thick PMMA is then injected in a controlled manner under low pressure into the cavity of the body. The bone tamp is deflated and removed. Kyphoplasty has been shown to provide significant pain relief as well as substantial improvement in the height of the collapsed vertebral body and has been found to reduce the spinal kyphosis[1].
Indication

Indications for kyphoplasty include painful or progressive osteoporotic and osteolytic vertebral compression fractures that do not compromise the spinal canal. The critical element in deciding a treatment regimen is pain and percentage of vertebral collapse. If a patient rates his/her pain as being greater than 4 out of 10 (when 10 equals worst pain imaginable and 0 equals no pain) or the vertebral bodies are collapsed more than 40%, then kyphoplasty or vertebroplasty is indicated as an initial intervention. Other patients may initially attempt more conservative care.[1]

Clinical Presentation

Sudden, severe back pain, worsening of pain when standing or walking, some pain relief when lying down, difficulty and pain when bending or twisting.
Loss of height, deformity of the spine - the curved, "hunchback" shape.
The pain typically occurs with a slight back strain during an everyday activity, like: lifting a bag of groceries, bending to the floor to pick something up, slipping on a rug or making a misstep, lifting a suitcase out of the trunk of a car, lifting the corner of a mattress when changing bed linens.The symptoms of spinal compression fractures are obviously different for every person. Therefore, any middle age or elderly person should see a doctor about the possibility of osteoporosis or spinal fracture -- especially if they have any symptoms.[2]

Diagnostic Tests

Radiography, CT scan and bone scintigraphy are the diagnositic tests of choice when a patient presents with spinal pain of traumatic or atraumatic origin, however, care must be taken to re test if initial tests are negative and pain persists.

Pre-Op

Physical therapy, analgesic medication, heat, massage and rest can all provide temporary relief of back pain, however, attention should be focused on preventing secondary complications such as progressive immobility and weakness. Pt's should avoid flexion exercises such as crunches and situps. Axial back extension strengthening exercises should be intiated within the patient's pain tolerance. Weight bearing exercises should be the hallmark of any program which attempts to minimize the affects of ostoeporosis, however, aquatic exercises[3] and balance training are also beneficial[4].  

Any patient with diagnosed osteopenia or osteoporosis should be on anti-osteoporotic medications, including second-generation bisphosphonates, as well as (daily) with 1500 mg of elemental calcium and 400 IU of vitamin D.

Post-Op

Most Kyphoplasty procedures are performed on an outpatient basis unless the patient has comorbidities requiring a short inpatient stay. Post-op treatment should be geared towards home safety training if the patient is at high risk for fall (Berg Balance Scale>40), pain management, and transfer training. Once the patient has recovered a program mentioned in the pre-op/non-op section should be initiated.

Key Evidence

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Resources

http://www.emedicinehealth.com/vertebral_compression_fracture/article_em.htm

http://web.ebscohost.com.dml.regis.edu/ehost/pdf?vid=5&hid=103&sid=bc9cf379-25b6-487a-be82-e0f59aade795%40sessionmgr112

Case Studies

http://web.ebscohost.com.dml.regis.edu/ehost/pdf?vid=4&hid=103&sid=bc9cf379-25b6-487a-be82-e0f59aade795%40sessionmgr112

Recent Related Research (from Pubmed)

References

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  1. 1.0 1.1 EMedicine Nonop treatment of vertebral compression fractures.http://emedicine.medscape.com/article/325872-treatment#TreatmentOtherTreatment
  2. WebMD,Symptoms of Compression fracture;http://www.webmd.com/osteoporosis/guide/spinal-compression-fractures-symptoms
  3. Devereux K, Robertson D and Briffa NK: Effects of a water-based program on women 65 years and over: A randomised controlled trial. Australian Journal of Physiotherapy 2005; 51: 102–108
  4. Koichi K, Daisuke S, Hitoshi W, Atsuko H, and Takeo N; A Comparison of the Effects of Different Water Exercise Programs on Balance Ability in Elderly People, Journal of Aging and Physical Activity, 2008, 16, 381-392