By Ehren Allen, PT, & Dr. Gregory Keller, Orthopedic Surgeon
Kyphoplasty is a minimally invasive surgery used to treat a spinal compression fracture. Spinal compression fractures occur primarily in spinal vertebrae that have been weakened due to osteoporosis but can as happen due to a fall or something like coming down on your head. Compression fractures most commonly occur in the thoracic area of the spine but may also occur in the lumbar spine as well.
What is Osteoporosis?
Osteoporosis (“porous bone”) is a disease characterized by low bone mass and structural changes in bones allowing them to become fragile and weak. This can lead to fracture even when there has been no significant trauma. The hip, wrist, and spine are the areas usually involved. Although we will all experience bone loss as we grow older, there are things that we can do to minimize the risk of fracture. Knowing that bone is laid down in the first three decades of life, the best prevention for osteoporosis is to build up strong bones during childhood and early adulthood.
Can You Prevent Bone Loss?
Adequate calcium and vitamin D intake and weight bearing exercise enables us to obtain maximum bone mass. Furthermore, avoidance of smoking and excessive alcohol intake can help slow the rate of bone loss. It is important to remember that bone loss occurs without symptoms, making osteoporosis a “silent disease.” Fortunately there is a safe and simple radiographic test that can determine whether you are at increased risk for fracture.
Most insurance companies will pay for this test, and every woman older than fifty should have her bone mass measured. For women at high risk (family history, long-term steroid use, and certain diseases), this study should be done even before menopause. Although there is no cure for osteoporosis, several medications have been approved by the FDA to treat this disease. If the condition is diagnosed early, then treatment can reduce the chances of a fracture. Unfortunately, the diagnosis of osteoporosis is often not made until a fracture occurs.
Symptoms of Kyphoplasty
Symptoms of a spinal compression fracture can vary. Usually, the first sign is severe back pain especially around the area where it can be very sensitive to touch. Sometimes if the area has collapsed, the vertebrae start(s) to compress one or more nerves, causing pain to radiate down the path of the nerve, such as into the arm or leg. Some other common symptoms of a compression fracture include:
- Pain when twisting or bending.
- Loss of height.
- A hunched forward position called kyphosis to help with decreasing the pain.
Fractures of the Spine
Fractures of the spine due to osteoporosis occur more than 700,000 times each year, affecting over a quarter of a million people. This makes it one of the most common causes of new onset back pain in older adults. These fractures can occur with little or no trauma. Patients with
painful spinal fractures due to osteoporosis generally receive conservative care.
This includes bed rest, bracing, and pain medication. Obviously these are not ideal solutions since these patients cannot afford to stay in bed until the fractures heal (this often requires 10 to 12 weeks). Even with a brace and pain medications, many patients are unable to resume an active lifestyle for many months. Open surgical repair of these injuries is rarely recommended.
The long-term consequences of the fractures can be devastating. There is 23-37% increased mortality compared to patients without such a fracture. This can be due to many factors including malnutrition, chronic obstructive pulmonary disease (COPD), and pneumonia. Patients
who survive are often plagued with chronic pain and deformity, which adversely affects their quality of life.
Fortunately, Kyphoplasty is a treatment for spinal fractures due to osteoporosis. First, a small incision is made in the back through which the doctor places a narrow tube under the guidance of fluoroscopy to guide it to the correct position. The tube creates a clear path through the back into the fractured area through the pedicle of the involved fractured vertebrae. A small balloon is inflated within the fractured vertebrae body. This allows the surgeon to elevate the compressed endplate back to its normal shape (which minimizes the resultant deformity). Cement is then packed into the void after the balloon is deflated and removed. As the cement hardens, it provides support for the fractured bone alleviating pain and preventing further deformity.
The procedure takes about an hour to perform and can often be done under IV sedation and local anesthetic. The only evidence that the patient has undergone surgery is the Band-Aid covering the entry sites. The results of this treatment can be dramatic. Patients who were previously unable to even sit up can often walk out of the surgery center or office within hours of the procedure.
Kyphoplasty gives us the opportunity to reduce the significant morbidity and mortality associated with vertebral compression fractures
due to osteoporosis. The spine center at the Jacksonville Orthopaedic Institute has been chosen as the only local site to have access to this new technology during the early phase of its introduction. If you or someone you know could benefit from this procedure, please discuss it
with you doctor or call us for a consultation.
Physical Therapy after Kyphoplasty Surgery
Kyphoplasty surgery may cause issues with maintaining a sitting or standing posture due to pain. Additionally, some patients may lose muscle tone and strength in their back. Physical therapy is frequently helpful for patients following surgery for these reasons.
The main goal of physical therapy is to help you safely improve strength, flexibility, mobility, ROM (range of motion), and overall function. During your course of physical therapy, your therapist may use treatments options such as:
- The use of heat and ice.
- ROM and flexibility/mobility exercises.
- Strengthening exercises to improve the strength of the spine and upper and lower extremities.
Your therapist will instruct you to maintain proper posture to reduce strain around the area of surgery. Remember, the main goal of physical therapy is for you to return back to your prior level of function. Your therapist will monitor your improvements as well as your limitations to adjust your course of treatment in a way to help achieve your treatment goals in a safe monitored setting. Each individual is different and each doctor is different with regards to physical therapy. Some doctors may prescribe physical therapy two or three times a week. Sometimes this lasts two to six weeks or more depending on your follow-up visit with your doctor.
- Related Article: Lower Back Anatomy
- Low Back Pain.
- Spinal Stenosis
- Herniated Lumbar Disc
To schedule an appointment at one of the 12 JOI Rehab Centers, please call 904-858-8045.
JOI & JOI Rehab
JOI and JOI Rehab work together to develop treatment protocols for spine injuries. A rehab protocol for the post-surgical treatment after Kyphoplasty has proven to produce superior outcomes. To schedule a new appointment with a JOI Spine Surgeon, you can call 904-564-2000 or schedule online.