Balloon Kyphoplasty

What is Balloon Kyphoplasty?

Balloon Kyphoplasty is a minimally invasive method of treating vertebral crush fractures (VCFs) seen in osteoporosis. The information contained within this page is intended to allow you to understand the procedure and gain an insight into what causes VCFs.

Osteoporosis

Osteoporosis is a condition which leads to low bone mass and structural deterioration of bone tissue. Affected individuals are at increased risk of fractures, especially of the hip, spine, and wrist.

Risk Factors for Osteoporosis

Women are particularly prone to suffering from this condition which occurs due to loss of bone tissue as a result of changes due to menopause. One in two women over 50 will suffer a fracture as a consequence of osteoporosis whereas only one in 4 men suffer fractures due to this condition.

Caucasian and Asian women are more prone to Osteoporosis as are small boned and thin women. There is also genetic susceptibility. Back to top

Degree of trauma necessary to cause fractures

Most vertebral compression fractures are caused by osteoporosis, a disease that causes bones to become brittle and break easily. As osteoporosis usually progresses without obvious symptoms, a person may not know that he or she has the disease until a fracture occurs.

Compression fractures can also occur as a result of certain types of cancer or tumors.

If bones are weak, everyday activities such as bending over to pick something up or carrying a bag of groceries, can cause the bones in the spine to break. Vertebral compression fractures usually cause severe back pain that comes on suddenly, although sometimes the pain can be dull and chronic in nature. Also, some fractures may be symptom less.

VCFs however, don’t have to be painful to have a profound effect on health and well-being. Back to top

Are vertebral compression fractures difficult to diagnose?

Vertebral compression fractures are under-recognized by doctors and patients alike, and in that respect, they are difficult to diagnose. About two-thirds of all osteoporotic spinal fractures are not diagnosed.

A person may have a spinal fracture and not have symptoms. On the other hand, a person with a spinal fracture may consider the discomfort simply “back pain,” and not realize the importance of having the source, or reason for the pain, correctly diagnosed. A complete physical examination, together with an x-ray and MRI, can help distinguish between pain caused by a vertebral compression fracture or something else. Also, it’s important to know whether or not you have osteoporosis, because with proper diagnosis and treatment, the disease progression can be slowed.

The presence of disabling backpain in the elderly must cause suspicion of VCF.

Physical examination

The physical examination should be performed with the patient standing, so that signs of osteoporosis, for example, kyphoscoliosis, are more apparent. Otherwise, the patient should lie on one side.

Beginning at the top and working down the thumb is pressed on or over the spinous processes to examine the spine. While VCFs can occur from the occiput to the sacrum, most often they occur in the midthoracic region (T7-T8) and at the thoracolumbar junction.

Pain associated with spinal palpation may indicate a compression fracture. Often, there is an accentuation of the normal spinal contour at the level of injury with associated prominence of the spinous processes in the painful area. The presence of a spinal deformity by itself does not indicate the cause or timing of the fracture. If there is no identifiable sharp pain, suspect other age-related spine problems.

Tapping with a closed fist gently over the spine sometimes causes pain due to micromovements at the fracture site. A neurologic examination should also be performed. Back to top

X rays

A symptomatic VCF does not always show collapse on the initial x-ray(X rays must include T5 to L5)

Magnetic Resonance Imaging (MRI)

If the source of pain remains undetermined, magnetic resonance imaging (MRI) may rule out a malignant tumor, identify the presence of a fracture, and help identify appropriate treatment. A T1 sequence of an acute fracture will be darker than other vertebral bodies; a T2 sequence will be brighter.

A short tau inversion recovery (STIR) sequence is ideal, because it is very sensitive for bony oedema following a VCF.

Routine imaging of the entire spine is probably not appropriate because of the expense.

If the MRI does not reveal edema, the fracture has most likely healed and is not the cause of the pain.

When an MRI is contraindicated, a technetium bone scan may be ordered instead although localization of the level of the fracture is less certain by this test.

Can a VCF that occurred a long time ago be treated with Balloon Kyphoplasty?

Age of the fracture and treatment success varies from patient to patient; however, surgeons generally agree that the earlier a fracture is treated, the better the outcome will be.

A full discussion of benefits and risks of the procedure will be discussed with you at your consultation. If you have any concerns about the procedure please ask Mr Bajekal during your consultation or telephone Dawn on 02083677007. Back to top

Balloon Kyphoplasty: The Procedure (Full animation)

	Balloon kyphoplasty is a minimally invasive technique in which an orthopaedic surgeon uses balloons to gently elevate bone fragments of a spinal fracture inorder to try and return them to the correct position..
	With a hollow instrument, the surgeon creates a small tunnel into the fractured bone. A small, specially designed balloon is then guided through the instrument into the fractured vertebra.
	The balloons are then cautiously inflated which reduces the fracture therby returning it to its correct position.
	Once inflated the balloons are then deflated which leaves behind a cavity within the spinal vertebrae.
	In order to stabilise the spinal vertebrae and prevent it collapsing down again, a special bone cement is injected which solidifies and secures the vertebrae.