Kyphoplasty
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Description
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Kyphoplasty is a newer percutaneous procedure that addresses the kyphotic deformity as well as the fracture pain (versus vertebroplasty which does not address the kyphotic deformity). Kyphoplasty involves the percutaneous insertion of an inflatable bone tamp into the fractured vertebral body under fluoroscopic guidance. The bone tamp is then inflated, elevating the endplates and restoring the vertebral body toward its original height. Thick PMMA is then injected in a controlled manner under low pressure into the cavity of the body. The bone tamp is deflated and removed. Kyphoplasty has been shown to provide significant pain relief as well as substantial improvement in the height of the collapsed vertebral body and has been found to reduce the spinal kyphosis[1].
Indication
Indications for kyphoplasty include painful or progressive osteoporotic and osteolytic vertebral compression fractures that do not compromise the spinal canal. The critical element in deciding a treatment regimen is pain and percentage of vertebral collapse. If a patient rates his/her pain as being greater than 4 out of 10 (when 10 equals worst pain imaginable and 0 equals no pain) or the vertebral bodies are collapsed more than 40%, then kyphoplasty or vertebroplasty is indicated as an initial intervention. Other patients may initially attempt more conservative care.[1]
Clinical Presentation[edit | edit source]
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Diagnostic Tests[edit | edit source]
Radiography, CT scan and bone scintigraphy are the diagnositic tests of choice when a patient presents with spinal pain of traumatic or atraumatic origin, however, care must be taken to re test if initial tests are negative and pain persists.
Pre-Op[edit | edit source]
Physical therapy, NSAIDs, heat, massage and rest can all provide temporary relief of back pain, however, attention should be focused on preventing secondary complications such as progressive immobility and weakness. Pt's should avoid flexion exercises such as crunches and situps. however, a superivised Pilates program may be on benefit. Back extension strengthening exercises should be intiated within the patient's pain tolerance. Weigh bearing exercises should be the hallmark of any program which attempts to minimize the affects of ostoeporosis, however, aquatic exercises and resistance training with weights can also be helpful.
Post-Op[edit | edit source]
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Key Evidence[edit | edit source]
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Resources
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http://www.emedicinehealth.com/vertebral_compression_fracture/article_em.htm
Case Studies[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 EMedicine Nonop treatment of vertebral compression fractures.http://emedicine.medscape.com/article/325872-treatment#TreatmentOtherTreatment Cite error: Invalid
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