Background Image
Previous Page  6 / 16 Next Page
Basic version Information
Show Menu
Previous Page 6 / 16 Next Page
Page Background

Balloon Kyphoplasty

6

An effective ‘minimal invasive’ cement injection

treatment of back pain caused by a crushed vertebrae

Balloon Kyphoplasty

Review of Kyphoplasty:

• Kyphoplasty is a low risk, minimally

invasive spinal surgery procedure

used to treat common painful and

progressive Vertebral body Collapses

or Fractures (VCFs) that typically go

unnoticed.

• The VCFs may be caused by

osteoporosis or spread of tumour

to the vertebral body.

• The procedure involves the use of

a balloon to restore the vertebral

body’s height and shape, followed

by bone cement augmentation to

strengthen it.

• The procedure is usually performed

as a daycase and under sedation or

general anaesthetic.

• The goal of the procedure is to:

• minimise pain

• allow early mobilisation and hospital

discharge

• improve quality of life.

Benefits of Kyphoplasty:

• Kyphoplasty has several benefits:

• It is a minimally invasive procedure.

• It restores vertebral body height

with a low risk of cement leakage.

• It is well tolerated and associated with

statistically significant improvements in

pain and function

(published clinical data).

• Published clinical data also shows that

patients benefit as much as 2 years after

the procedure

(most bene cial results if

performed within 6 months of symptom onset).

• Offers the additional benefit of restoring

vertebral height towards the pre-fracture

anatomy with restoration of normal spinal

balance, and therefore reduces the risk of

further fractures.

• This height restoration may, in turn,

improve lung mechanics and decrease

muscular and ribcage pain.

Guidelines

Kyphoplasty is appropriate when

there is:

1. Osteoporotic vertebral collapse causing

persistent activity limitations and

debilitating pain that has not responded

to standard medical treatment (e.g.

physiotherapy, analgesics, external bracing,

with or without bed rest).

2. Evidence of progression of vertebral

collapse.

3. Presence of neoplasms or other bone

pathology causing persisting or progressive

pain, progressive bone destruction or

imminent risk of vertebral collapse.

Kyphoplasty is NOT appropriate

in patients with:

1. Spinal curvatures, (e.g. scoliosis or kyphosis)

due to causes other than osteoporosis.

2. Spinal stenosis or disc herniations with

nerve or spinal cord compression and loss

of neurological function not associated

with a collapse or fracture.

Referral Process (see flow chart):

If you suspect a patient has

suffered a vertebral fracture:

• Confirm fracture via x-ray and/or Magnetic

Resonance Imaging (MRI)

NICE guidelines

(www.nice.org.uk

)

suggest

patients should undergo conservative

medical management for 6 weeks initially.

• If pain persists, then refer to local

Kyphoplasty specialists (see names of

clinicians) for assessment on the suitability

for Kyphoplasty/vertebroplasty.

• Following the procedure, NICE

recommends that all patients are referred

for physiotherapy and management of their

osteoporosis.

RISK FACTORS

- Postmenopausal > age 55

- Known osteoporosis

- Low weight

- Steroid use

- PreviousVCF

- Height loss ≥ 2cms

SUSPECTEDVCF

- Refer for standing AP + Lateral x-ray

NO

NO RESPONSE IN 6WEEKS

NO

NO

YES

YES

YES

LEG PAINAND/ORWEAKNESS?

VCFAT CLINICALLY PAINFUL LEVEL?

Level of pain, disability,

or deformity…

High disability and/or

Pain score ≥ 4

ALL PATIENTS

Manage underlying osteoporosis

• Obtain DEXA to diagnose

osteoporosis

• Add Calcium andVitamin D

• Add bisphosphonates

• Recommend dietary changes

and exercise

Low disability and/or

Pain score ≤ 4

MRI + STIR

EVIDENCE OF OEDEMA?

Non-healedVCF

HealingVCF

IMMEDIATE REFERRAL

TO SURGEON

If pain persists ≥ 2 weeks

- Consider repeat x-ray studies

looking for further collapse

- Another new fracture

- Alternative diagnosis

HISTORy

- Sudden onset acute

back pain

- Mechanical pain

improved lying flat

- Minimal / no trauma

or recent fall

PHYSICAL EXAMINATION

- Height loss ≥ 2cms

- Thoracic hyperkyphosis

- Percussion tenderness over

fracture site (junctional areas)

- Flexion pain

NON-SURGICAL

MANAGEMENT

• Pain management

• Exercise

• Physical therapy

SURGICAL

MANAGEMENT

• Kyphoplasty

•Vertebroplasty

• Open Surgery (if appropriate)

Alternative diagnosis, i.e. infection,

metastasis, inflammatory disorders,

spinal stenosis

All referrals to: Mr Khai Lam (Consultant Spinal Surgeon), and/or Dr Tarun

Sabharwal (Consultant Interventional Radiologist).Tel:

020 7234 2009