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Lumbar Kyphoplasty

What does “Lumbar Kyphoplasty” mean?

Here is the meaning of each word:

  1. Lumbar: area of the spine located in the low-back
  2. Kyphoplasty: it is essentially a Vertebroplasty procedure performed with additional instruments. The term “Kypho” comes from the name of the company which manufactures the equipment (Kyphon).

Altogether, “Lumbar Kyphoplasty” means performing a procedure on a broken vertebrae similar to a Vertebroplasty, but using additional equipment in the form of small balloons.

What is a Lumbar Kyphoplasty procedure?

A Lumbar Kyphoplasty is a minimally invasive spine procedure. One or more small metal tubes are placed into a fractured vertebra. Balloons are then placed into the vertebra through the tubes and inflated under high pressure. This can potentially raise the compressed vertebra. Following that, bone cement (Poly-Methylmethacrylate=PMMA) is injected.

Why is a Lumbar Kyphoplasty done?

A Lumbar Kyphoplasty procedure is done to help with the pain from a compression fracture of a vertebra. The procedure also adds stability to the vertebra potentially preventing more collapse.

What is a Lumbar Compression Fracture?

A compression fracture [link] is a fracture of the body of the vertebra. The vertebra typically looks like a wedge rather than a square when this type of fracture occurs. This is due to a collapse of the front part of the vertebra.

What is the difference between a Lumbar Vertebroplasty and a Lumbar Kyphoplasty?

The main difference between the two procedures is the use of a high pressure plastic balloon in the Kyphoplasty procedure. The balloon is placed into the collapsed body of the vertebra through metal straws. This balloon once inflated, could potentially raise the collapsed vertebra and restore some of the lost height again.

What is Bone Cement (poly-methylmethacrylate)?

Polymethyl-methacrylate (PMMA) is a commonly used bone cement. It is often used to secure a new hip (hip replacement) or knee joint (knee replacement) to the bones. PMMA comes as a semi-fluid with a consistence comparable to soft cake batter. It can be injected through a syringe under pressure. Once it reaches the vertebra it begins to harden. Eventually it will have a similar consistency as the bone around it.

How does Bone Cement help a Lumbar Compression Fracture?

Once PMMA is injected into a vertebra it can stabilize the broken bone to avoid further collapse. This stability can lead to pain relief. PMMA also heats up as it hardens which can disrupt small nerve fibers which carry pain sensation. Another reason for pain relief is one of the chemicals in PMMA which can disrupt small nerves directly.

How is a Lumbar Kyphoplasty procedure done?

Here are the steps for how a Lumbar Kyphoplasty is done:

  1. An intravenous catheter (IV) is started on the patient.
  2. Often patients get antibiotics through the IV before the procedure.
  3. This procedure is done in a Procedure Room or Operating Room.
  4. The patient is initially place on their back (supine).
  5. After a General Anesthetic is given, the patient is carefully placed on their stomach.
  6. The low-back (lumbar spine) is cleaned with a surgical antiseptic and sterile sheets (drapes) are placed around this area of the spine.
  7. With the help of an X-Ray machine the doctor places a thin metal tube (trocar) through the skin and into the pedicle of the vertebra (bridge between the arch and body of the vertebra).
  8. The metal tube is then carefully pushed forward with the help of the X-Ray machine until it reaches the collapsed body of the vertebra.
  9. A balloon is now placed through the metal straw into the collapsed vertebra. The balloon is inflated with contrast dye under high pressures (up to 200 psi or more). This pressure can potentially raise the collapsed segment of the vertebra. The balloon also creates a “cave” inside the collapsed vertebra. This cave can eventually be filled with PMMA.
  10. PMMA is prepared and placed inside a syringe. The PMMA contains a chemical called Barium Sulfate. This is a material which can easily be seen on an X-Ray machine. Having it be part of the chemicals in the PMMA, will allow the doctor to see the PMMA as it is injected into the vertebra.
  11. At this point, the balloon is removed.
  12. With the help of the X-Ray machine, the PMMA is now slowly injected into the collapsed vertebra. The doctor pays careful attention to the spread of the PMMA inside the vertebra.
  13. Once the injection is complete, the metal tubes are taken out.
  14. Band-aids or a bandage are placed over the site where the metal tube was placed through the skin.
  15. The patient is turned on their back (supine) and awoken from Anesthesia.
  16. The patient is then brought to the Recovery Area for observation.

How long does it take to perform a Lumbar Kyphoplasty?

Typically a Thoracic Kyphoplasty takes 30-45 minutes to complete for one broken vertebra.

What is the recovery from a Lumbar Kyphoplasty like?

  1. This procedure is typically done as an outpatient.
  2. The patient is usually given restrictions on activity such as bending and lifting for a period of time.
  3. The small skin punctures will heal within 7-10 days.
  4. The patient is often evaluated again by the doctor within several weeks. More X-Rays are often taken at that time.

What kind of benefit can patients gain from a Lumbar Kyphoplasty?

Most patients receive very quick pain relief, typically within 24 hours. This relief is usually for the long term.