Vertebroplasty VS Kyphoplasty

Osteoporosis, a condition that weakens the bones, making them more fragile and more likely to break, is one of the most common degenerative spine disorders. The condition causes your vertebrae to collapse, possibly resulting in spinal cord injuries or nerve root compression. The collapse of the vertebrae can also be caused by spinal tumors and traumatic injuries. These conditions are mostly treated with a surgical approach: Vertebroplasty and Kyphoplasty.

Despite being used as a surgical method to treat collapsed vertebrae, the procedures are different. In this article, we provide you with information about vertebroplasty vs kyphoplasty: What are the differences?

What is Vertebral Compression Fractures (VCF)

Vertebral Compression Fractures (VCF) are defined as a spinal compression fracture that occurs when the vertebrae break. The vertebrae, which are small bones aligning themselves into the spinal column, are the main core of stability in our bodies. VCF occurs when the vertebrae collapse, either from the injury or the spine disorder. The collapse causes the pressure to be applied to the vertebrae more than normal, making the structure shift or become misshapen. This causes nerve root compression, blood circulation blockage in the affected areas, and possible spinal cord injury.

VCF is treatable with surgical approaches. Mostly, patients with VCF are likely to undergo either vertebroplasty or kyphoplasty, depending on the conditions and the diagnoses. The physician will make a decision regarding which one to perform: vertebroplasty vs kyphoplasty.

What is Vertebroplasty

Vertebroplasty is a procedure performed to correct a spinal compression fracture. The technique involves the percutaneous injection of bone cement into the cancellous bone of a vertebral body, repairing the broken bone and providing pain relief. The goals of Vertebroplasty are pain relief and preventing further loss of vertebral body height, which is important to the entire structure of the spine. The procedure is mostly used to seal the fractures and stabilize the spine.

Vertebroplasty, in contrast to Kyphoplasty, uses no balloon. Suitable candidates for Vertebroplasty technique are those who have mild compression fractures. Hence, the question of which procedure is suitable for you: Vertebroplasty vs Kyphoplasty, depends on your conditions and your doctor. Make sure to seek professional advice on this matter.

What is Kyphoplasty

Kyphoplasty, which is similar in terms of use to vertebroplasty, is another surgical technique for the treatment of vertebral compression fractures. Kyphoplasty utilizes an inflatable balloon in the fractured bone to create a cavity for the cement. This technique aims to restore the height of the vertebrae, stabilize the spine, relieve the pain, and reduce kyphosis. People with osteoporosis can consider this method to ensure that the height of their spine maintains a suitable level.

Despite being similar to Vertebroplasty, the indications for Kyphoplasty are somewhat different. You should consult your doctor about your conditions and your goal, to decide which surgery you should undergo: Vertebroplasty vs Kyphoplasty.

Why are Vertebroplasty and Kyphoplasty Necessary

It is undeniable that our health gradually deteriorates as we age. In normal conditions, the spine is likely to get more fragile and is likely to break due to the natural, degenerative status of our bodies. Moreover, in people who are at higher risks of developing osteoporosis or developing other spine disorders, the vertebrae are more likely to collapse, making Vertebral Compression Fractures (VCF) possible. The complications of said conditions are various: nerve root compression, spinal cord injuries, spinal stenosis, etc. Hence, it is important that you get a precise diagnosis and have proper treatment on time.

Vertebroplasty and Kyphoplasty are two of the most effective and common surgical techniques for the treatment of vertebral compression fractures. Despite their subtle differences in terms of procedures and treatment goals, they share similar benefits and advantages. The surgical approach may be specifically suggested if you are experiencing difficulties performing daily routines. The methods relieve pain while also improving your quality of life. Therefore, in cases of the aforementioned conditions, you should seek professional advice on this matter: Vertebroplasty vs Kyphoplasty, which one is the best option for you?

Vertebroplasty and Kyphoplasty Procedure

Before the surgery, either Vertebroplasty or Kyphoplasty, you have to undergo a thorough physical examination first. A radiological diagnosis, most likely done by X-rays, is needed to confirm the correct level of the fractured vertebrae. After the level of the collapsed spine has been confirmed, you are to prepare for the surgery.

Here are steps of Vertebroplasty and Kyphoplasty procedure.

Vertebroplasty:

• You will be given sedatives or anesthetics, depending on your condition.
• You will lie on the bed face down on the surgical bed.
• The doctor will make a small incision on your back, at the level of the collapsed spine.
• The needle will be inserted into the vertebrae, injecting the cement to fuse and stabilize the fractured vertebrae.
• Once in position, the cement generally takes approximately 10 minutes to harden, solidifying the fragments of the fracture and providing the spinal stability.
• Usually, the procedure lasts about an hour.

Kyphoplasty:

• Similar to Vertebroplasty, you will be given sedatives or anesthetics.
• You will be positioned face down on the operating table.
• A balloon catheter will be guided into the vertebra using X-ray guidance, and inflated with a liquid under pressure.
• As the balloon inflates, it can help restore the collapsed vertebrae. The height of the vertebrae is likely to be restored as well.
• After the balloon is maximally inflated, it is deflated and removed. A cavity is then created to be filled with bone cement, stabilizing the spine.
• The cement hardens in place, maintaining the correct position of the spine as well as stabilizing the vertebrae.
• The procedure usually lasts about an hour, just like Vertebroplasty.

As described in previous sections, the main differences between Vertebroplasty and Kyphoplasty are the use of balloons and the height restoration. It is recommended that you seek medical advice about which procedure is most suitable for you: Vertebroplasty vs Kyphoplasty.

Vertebroplasty VS Kyphoplasty Comparison

Vertebroplasty vs Kyphoplasty procedure can be a little confusing in terms of processes and details. Here are some examples of subtle differences between Vertebroplasty and Kyphoplasty.

• Vertebroplasty is likely done with patients lying awake, but under the effects of sedatives. Kyphoplasty, on the contrary, is commonly done under general anesthesia or local anesthesia.
• In Vertebroplasty procedure, the material is placed directly into the fracture site. There is no manipulation of the vertebra from within using medical instruments. However, Kyphoplasty uses balloons to inflate and create gaps in the vertebrae, filling it with bone cement to restore the normal structure of the vertebrae.
• Cement injection in Vertebroplasty usually involves the fracture ligaments, binding them together in the position they are in. In Kyphoplasty, the cement usually hardens in place, maintaining the correct position of the vertebrae.

Potential Risks of Vertebroplasty and Kyphoplasty Procedure

Every surgical approach contains potential risks, so it is important that you learn about those possibilities before making a decision. Most of the time, the doctor will weigh the pros and cons of surgery, and discuss the treatment plan and goals with you. However, the risks of complications are still possible. Here are some examples of the potential risks of Vertebroplasty and Kyphoplasty.

• A new fracture site can still occur.
• Spinal infections (rare, but possible).
• Spinal nerve damage, causing pain in the back or the legs or weakness in the arms/the legs for several weeks after surgery.
• Inflammation.
• Cement leakage. It can leak through the back of the spine and compress the nerve, resulting in nerve irritation. (rare, but also possible).

Vertebroplasty and Kyphoplasty Post-Operative Care

After surgery, you will be transported back to the recovery room. Your conditions, vital signs and any possible side effects, will be closely and constantly monitored. The nurse will assess back pain for the next 2 hours as well. During your hospital stay, you are not limited to only bed rest. Walking and moving around as you can tolerate is generally encouraged.

Vertebroplasty and Kyphoplasty usually offer you a short length of hospital stay: an overnight after surgery. Normally, people can get back to their routines without further complications.

What happens before you can leave the hospital

Generally, painkillers will be prescribed to you by your doctor. You are required to stay overnight at the hospital to monitor your conditions regarding the complications. Some medications can be addictive, so you should be in your doctor’s care.

Constipation is usually common as it is one of the possible side effects of medications. Paracetamol may be prescribed to you if you experience little pain. You are advised to drink water to stay hydrated, and eat healthy, fiber-rich foods as well.

Activities that you should do or should not do

• Avoid performing strenuous or extreme activities.
• Avoid bending or twisting your back and waist. Improper posture, such as slouching posture, should be avoided as well.
• Avoid lifting heavy objects that weigh more than 5 kg.
• Refrain from driving for a period of 2 weeks.
• Wearing a brace. Depending on your doctor’s advice, you may wear it during the day-time, but not necessarily when you sleep.
• Avoid a prolonged period of sitting, approximately 20-30 minutes in each time.
• Walking is encouraged. You can walk as much as you can tolerate the pain. It is important that you do not overexert yourself.
• Walking up and down stairs is generally encouraged. You can do it as much as you can tolerate. Be careful not to fall.
• It is suggested that you lie sideways before getting out of bed.

Wound care

Keep the wound dry and clean within the first 24 hours. After that, you can take a shower. Taking a bath is not recommended as it will soak the wound. After the shower, gently pat the wound and let it dry.

You should see a doctor immediately if

• You have a fever. (a body temperature higher than 38 Co)
• Your wound gets red or swollen.
• There’re secretions leaking from the wound.
• You have difficulty walking.
• Your urinary and excretory system have changed their function pattern.
• You experience increased back pain.
• Your chest feels tight or you have trouble breathing.

Vertebroplasty VS Kyphoplasty Conclusion

Vertebroplasty and Kyphoplasty is one of the most common surgical techniques for the vertebral compression fractures. The procedures are generally safe. The suitable candidates for the techniques are those who have fractured or collapsed vertebrae. Vertebroplasty and Kyphoplasty are similar, but somewhat different in terms of procedure details and treatment goals. It is recommended that you seek professional advice regarding this matter.

Dr.Sittipong Suttiudom
Neurological Surgery/Spine
Spine Center

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