Kyphoplasty Procedure at HMC Offers Relief for Many
A spinal fracture sounds like serious injury and indeed it is. But fortunately there is a safe, non-invasive procedure that can work wonders in both healing the damage and relieving the pain associated with it.
Kyphoplasty is a non-invasive surgical procedure that stabilizes the bone, re-establish any height lost to the fracture (due to the compression that the fracture causes) and, first and foremost, to alleviate the pain caused by the injury.
"It is both palliative and curative," said Dr. Mrinal Mali, a neuroradiologist at Holyoke Medical Center. "The first goal is to relieve the pain, then get people back on their feet again."
The procedure is fairly straightforward and can usually be conducted under local anesthesia, Mali said. After preparing the patient for surgery by cleaning the back area, the patient lies on his or her stomach and a small incision is made near the fracture through which the doctor places a very small needle. The physician uses fluoroscopy to adjust the needle into the correct position. This needle creates a pathway through the back into the fractured area of the affected vertebrae.
Then, under fluoroscopy, a small, high-tensile balloon is inserted through the needle and into the vertebrae. The balloon is then carefully inflated to elevate the compression caused by the fracture and return it to a more normal position. It also gently pushes outward to create a cavity inside the fractured vertebrae. The balloon is removed and the doctor uses specially designed instruments to fill the cavity with a medical cement called polymethylmethacrylate . After being injected, this pasty material hardens quickly, stabilizing the bone.
The patient's recovery time is usually within 24 hours after the kyphoplasty procedure is performed. Patients can not drive right away, however, and need to schedule transportation home from the hospital.
"Pain relief will be often immediate for many patients and most people can return to their regular, daily activities within two or three days," said Mali. "More strenuous tasks, such as those involving heavy lifting, should be avoided for a few weeks, and only engaged in after consulting with the physician."
There are very few contraindications that prevent candidates from undergoing kyphoplasty, Mali said.
"The only real contraindication is if the person is allergic to the medical cement," he said. "But that is very rare." Mali added that certain patients with severe disabilities might also not be good candidates for the procedure.
But not all vertebrae fractures are treatable by kyphoplasty, Mali added. The procedure is indicated only if the fracture is fairly new. After a few weeks an acute fracture starts to heal and can become a chronic fracture. As the bone hardens, using kyphoplasty becomes untenable. Traditional treatment used to involve waiting a month or more to see if patients improved on their own, but now it's widely held that that waiting just allows this hardening of the bone, making kyphoplasty less effective. Many doctors are now suggesting kyphoplasty as soon as the first week after a fracture because it improves treatment results significantly.
Kyphoplasty is an alternative to an older, similar treatment known as vertebroplasty. In vertebroplasty, however, the medical cement is injected through the hollow needle directly into the fractured bone, without the balloon being first inserted to elevate the height of the fracture. Mali said that kyphoplasty allows more pinpoint control of where the medical cement is placed. Both procedures are extremely safe, Mali said.
The most common use of kyphoplasty is to treat fractures due to osteoporosis, particularly in the elderly. But it also in employed to treat and strengthen fractures with tumors and trauma, Mali said. The procedure is relatively new, having been on the medical scene for about 15 years. Mali has been performing it for close to a decade.
To contact the Radiology Department at Holyoke Medical Center, call (413) 534-2523