Vertebral Augmentation

Expanded Guide

Vertebral augmentation, commonly known as kyphoplasty, is a minimally invasive procedure used to treat vertebral compression fractures (VCFs) in the spine, particularly in the thoracic (mid-back) and lumbar (lower back) regions. These fractures are most often caused by osteoporosis, a condition that weakens bones, making them more susceptible to fractures. However, kyphoplasty is also used for patients with fractures from trauma or those weakened by metastatic cancer. Thoracolumbar compression fractures, which occur in the lower thoracic and upper lumbar vertebrae, are especially common and can cause severe pain, spinal deformity, and reduced mobility. Kyphoplasty is performed to stabilize these fractures, alleviate pain, and restore height and alignment to the affected vertebrae.

Procedure and Mechanism of Kyphoplasty

The kyphoplasty procedure typically begins with the patient under local or general anesthesia, depending on individual needs and the complexity of the case. Guided by fluoroscopic imaging (a type of real-time X-ray), the physician makes a small incision and inserts a narrow tube through which a small balloon catheter is introduced into the fractured vertebra. The balloon is carefully inflated, creating space and restoring a degree of height lost due to the compression fracture. This inflation helps correct spinal deformity and may reduce the risk of further collapse.

Once the balloon has expanded to the desired height, it is deflated and removed, leaving a cavity within the vertebra. This cavity is then filled with a bone cement called polymethylmethacrylate (PMMA), which quickly hardens, stabilizing the fracture and relieving pain. The procedure is minimally invasive and takes approximately 30 to 60 minutes per vertebra, with most patients able to go home the same day.

Indications for Kyphoplasty in Thoracolumbar Compression Fractures

Kyphoplasty is commonly recommended for thoracolumbar compression fractures, which can cause localized back pain, spinal deformity (such as a humped back), and limited mobility. Patients with osteoporosis are particularly susceptible to these fractures, as are those with cancer that has spread to the spine, leading to weakened vertebrae. In cases where conservative treatments like bed rest, pain medications, and physical therapy have not provided adequate relief, kyphoplasty becomes a valuable option. The procedure is effective in not only relieving pain but also improving vertebral stability and restoring lost vertebral height, which can reduce postural issues and protect adjacent vertebrae from additional fractures.

SpineJack Implant: An Alternative to Traditional Kyphoplasty

The SpineJack implant is a relatively new innovation in vertebral augmentation and serves as an alternative to traditional kyphoplasty. Instead of using a balloon to create space within the vertebra, the SpineJack device, which resembles a small metal jack, is implanted into the vertebral body to manually expand the collapsed area. The SpineJack allows for precise control in restoring vertebral height, potentially achieving even better results in terms of spinal alignment and stability. After the SpineJack is inserted and expanded, bone cement is injected to solidify and maintain the vertebra’s new structure.

Studies comparing the SpineJack implant with traditional kyphoplasty show similar rates of pain relief, but SpineJack may offer better restoration of vertebral height and improved correction of spinal alignment. Additionally, the implant’s design may help reduce the risk of adjacent fractures, a common issue when one vertebra’s structure is corrected, but adjacent bones remain weak or unstable. This approach is becoming increasingly popular among patients with severe spinal deformities or those at high risk for future fractures.

Benefits

Vertebral augmentation, or kyphoplasty, offers several important benefits for individuals suffering from vertebral compression fractures. One of the primary advantages is significant pain relief, which many patients experience within days of the procedure. By using a balloon to create space within the vertebra before filling it with bone cement, kyphoplasty helps restore some of the lost vertebral height, which reduces spinal deformity and aids in stabilizing the spine. This stability often leads to increased mobility, allowing patients to resume daily activities with greater comfort and ease. Being a minimally invasive procedure, kyphoplasty involves a small incision with minimal tissue disruption, resulting in a quicker and less painful recovery compared to open surgery. Most kyphoplasty procedures are done on an outpatient basis, so patients can go home the same day. The combined effect of pain relief and improved mobility often enhances patients’ overall quality of life, allowing them to engage in activities they enjoy. Additionally, by stabilizing the fractured vertebra, kyphoplasty reduces the risk of further fractures and complications associated with spinal misalignment. With a low complication rate, typically less than 2%, kyphoplasty is generally considered safe and suitable for many patients, including older adults.

Conclusion

Vertebral augmentation through kyphoplasty is a highly effective treatment for thoracolumbar compression fractures caused by osteoporosis, cancer, or trauma. By stabilizing the fractured vertebra, restoring height, and reducing pain, kyphoplasty allows patients to regain mobility and improve their quality of life. The SpineJack implant represents an exciting advancement in this field, offering precise height restoration and enhanced structural stability, particularly beneficial for patients with severe deformities. Together, kyphoplasty and SpineJack provide safe and effective solutions for managing painful vertebral fractures, giving patients an alternative to prolonged pain management and conservative treatments that may not provide adequate relief.