Vertebral Augmentation/Ablation

An interventionalist who specializes in this procedure will see you for consultation and evaluate you and your history to make sure you can benefit from the procedure. An image of your spine and lab work usually is ordered in preparation for the kyphoplasty procedure.

During the procedure, bone cement is injected with a biopsy needle into the collapsed or fractured vertebra. The acrylic cement quickly dries and forms a support structure within the vertebra that provides stabilization and strength. Kyphoplasty attempts to restore the height and angle of kyphosis of a fractured vertebra (of certain types), followed by its stabilization using injected bone filler material. The procedure typically includes the use of a small balloon that is inserted and inflated in the vertebral body to create a void within the cancellous bone prior to cement delivery. Then bone cement is typically delivered directly into the newly created void.

A clinical staff member will bring you into the pre-procedure area and ask you to change into a gown. An intravenous (IV) line will be inserted into a vein in your hand or arm. Your doctor will greet you, review the procedure, and answer any questions you may have. You will be brought into the procedure room, and you‘ll be positioned on the procedure table. You will be connected to a monitor for your heart rate, blood pressure, and pulse. The technologist will sterilize and cover the area of your back where the needle will be inserted with a surgical drape. A very small nick is made in the skin at the site.

Using X-ray guidance, a hollow needle called a trocar is passed through the spinal muscles until its tip is precisely positioned within the fractured vertebra. An examination called intraosseous venography may be performed by some interventional radiologists to make sure the needle has reached a safe spot within the fractured bone. However, many interventional radiologists proceed with vertebroplasty or kyphoplasty directly and skip the intraosseous venography part of the exam.

In kyphoplasty, the balloon tamp is first inserted through the needle and inflated, pushing the bone back to its normal height and shape and creating a hole or cavity. The balloon is then removed and the bone cement is injected into the cavity created by the balloon. The trocar is then removed.

Pressure will be applied to stop any bleeding and the opening in the skin is covered with a bandage. No sutures are needed.

You will remain in the recovery room for several hours following the procedure to monitor for any increased back pain or other complications.

There are things you can do to make your experience more comfortable, and many of these will depend on your individual preferences. You might like to keep a list of questions or – as you’re doing now – educate yourself about the procedure.

Another important part of your preparation will be guided by your doctor:

• Several days before the procedure, you will have a consultation with the interventional radiologist.
• Your doctor may ask you to stop taking aspirin, non-steroidal anti-inflammatory drugs (NSAIDs), or blood thinners (such as Coumadin, Warfarin, Plavix, Fragmin) for a time before the procedure.

Some of your preparation will need to be timed to the procedure:

• The day before the procedure (or the Friday before, if you’re scheduled for a Monday procedure), a clinical staff member from the Interventional Radiology Department will call you. The clinical staff member will give you any additional instructions and will ask if you have any questions.
• Take your medications as instructed.
• When you arrive, make sure the clinical staff member and radiologist know about any allergies you may have, especially allergies to local anesthetics (such as lidocaine), general anesthetics, or X-ray dye (contrast media). If there’s any chance you might be pregnant, tell your radiologist.

• Wear comfortable, loose-fitting clothes.
• Wear comfortable shoes.
• Bring a list of your current medications with dosages.
• Avoid bringing jewelry or valuables.

The benefits of kyphoplasty:

• Kyphoplasty can increase a patient’s functional abilities, allowing a return to the previous level of activity without any form of physical therapy or rehabilitation, and prevent further vertebral collapse.
• These procedures are usually successful at alleviating the pain caused by a vertebral compression fracture; many patients feel significant pain relief almost immediately. Many patients become symptom-free.
• Patients regain lost mobility and become more active, which helps combat osteoporosis. After the procedure, patients who had been immobile can get out of bed, reducing their risk of pneumonia. Increased activity builds more muscle strength, further encouraging mobility.
• Usually, kyphoplasty is a safe and effective procedure.

Risks you should be aware of include:

• Any procedure where the skin is penetrated carries a risk of infection.
• A small amount of cement can leak out of the vertebral body. This does not usually cause a serious problem unless the leakage moves into a potentially dangerous location such as the spinal canal.
• Other possible complications include bleeding, increased back pain, and neurological symptoms such as numbness or tingling.
• Paralysis is extremely rare.
• There is a risk of an allergic reaction to the contrast material used for intraosseous venography or to help visualize the balloon as it inflates on the X-ray image.

Keep in mind that this information is general. Your radiologist is the best source of information about how these risks and benefits may apply to you.