kyphoplasty, vertebroplasty (kyphon - kyph)

Osteoporotic compression fractures of the spine (thoracic and lumbar) can be very painful.  Two techniques which are available to improve pain from osteoporotic compression fractures of the spine, and restore some of the height of the vertebral body lost in a compression fracture.  These techniques are known  as vertebroplasty and kyphoplasty (Kyphon - kyph).  Both techniques ( vertebroplasty and kyphoplasty) involve injecting  cement into the collapsed vertebral body in either the thoracic spine or the lumbar spine, or both.  With vertebroplasty the cement is injected into the collapsed vertebral body, whereas with kyphoplasty (kyphon - kyph),  the vertebral body is first opened up or reduced, by the use of a balloon on each side of the vertebral body.  During kyphoplasty (kyphon - kyph), the balloon and cement are introduced through the pedicle of the vertebrtal body. 

Both techniques, vertebroplasty and kyphoplasty (kyphon - kyph) have increased risk when there is siginficant retropulsion of bone into the spinal canal.  This is because, when the cement is introduced during either technique (vertebroplasty and kyphoplasty (kyphon - kyph)), it may leak back into the spinal canal, and impinge on the spinal cord or nerve roots. 

Both procedures (vertebroplasty and kyphoplasty (kyphon - kyph) are performed under x ray guidance.  This allows the spine surgeon or neurosurgeon to make a small incision is made in the back at the appropriate level, and the procedure is done under fluoroscopy. 

In cases where appropriate, both vertebroplasty and kyphoplasty (kyphon - kyph) can be used at more than one level.

Technique of Kyphoplasty

The normal bones of the spine (thoracic or lumber) have a rectangular appearance, as is seen here. On top of, and below the bone, are the intervertebral disc spaces.

When bone in the spine becomes weak, as happens in the case of aging, it may have an increased risk of fracture.  This fracture typically takes on the appearance in which the end plates on the top and bottom of the vertebral body come closer together.  This is typically the appearance of an osteoporotic compression fracture.  A compression fracture may also occur when there is tumor within the substance of the vertebral body, and this is known as a pathologic fracture.

During the kyphoplasty procedure, an opening is made, through the skin, into the pedicle, and subsequently into the vertebral body of the spine.  The hole is large enough to pass a small balloon.

Once the balloon is inserted, it is inflated, to expand the vertebral body, and "reduce" the spinal osteoporotic compression fracture.  Sometimes the compression fracture can be improved in height substantially, and at other times, only partially.

Once the cavity has been created in the osteoporotic spinal bone, the balloon is removed, leaving a hollow space.

The cavity of the spinal osteoporotic compression fracture is then filled, in a low pressure manner, with cement.

When the cement hardens inside the spinal osteoporotic compression fracture, an internal cast is created.  This internal cast will provide additional substance and support to the osteoporotic compression fracture, resulting in decreased pain in most cases.