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Thoracic Kyphoplasty Procedure

What does “Thoracic Kyphoplasty” mean?

Here is the meaning of each word:

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

Altogether, “Thoracic Kyphoplasty” means injecting material into a collapsed vertebra with the help of small instruments such as balloons.

What is a Thoracic Kyphoplasty procedure?

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

Why is a Thoracic Kyphoplasty done?

A Thoracic Kyphooplasty procedure is done to help with the pain from a compression fracture of a vertebra. It will also help with the stability of the fractured vertebra.

What is a Compression Fracture?

A compression fracture 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 the collapse of the front part of the vertebra.

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

The main difference between the two procedures is the use of a high power plastic balloon in the Kyphoplasty procedure. This balloon once inflated inside the fracture, could potentially raise the collapsed vertebra and restore some of the lost height.

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 Thoracic 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 that carry pain sensation. Another reason for pain relief is one of the chemicals in PMMA which can disrupt small nerves directly.

How is a Thoracic Kyphoplasty procedure done?                                       

Here are the steps for how a Thoracic 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 mid-back (thoracic 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) into the pedicle of the vertebra (bridge between the arch and body of the vertebra) [link].
  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. Often metal tubes are place on both sides of the vertebra to be able to reach all of the fracture.
  9. Once the location of the tip of the metal tube is satisfactory, PMMA is prepared and placed inside a syringe. A chemical Called Barium Sulfate is part of the PMMA. This chemical is easily seen on an X-Ray. 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.
  10. 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.
  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 where the balloon was previously located. 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 tubes were 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 Thoracic Kyphoplasty?

Typically a Thoracic Kyphoplasty takes about 30-45 minutes to complete for each vertebra.

What is the recovery from a Thoracic Kyphoplasty like?

Here are some of the steps in the recovery from this procedure:

  1. This procedure is typically done as an outpatient.
  2. The patient is usually given restrictions on activity such as bending and lifting.
  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 Thoracic Kyphoplasty?

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