Patient education: Vertebroplasty and kyphoplasty (The Basics)

What are vertebroplasty and kyphoplasty? — These are 2 procedures used to treat pain from a recent vertebral compression fracture.

"Vertebral" means related to the back bones, which doctors call the "vertebrae" (figure 1). A "fracture" is another word for a broken bone. A vertebral compression fracture is when a back bone breaks by collapsing.

Some doctors recommend vertebroplasty or kyphoplasty only in certain situations, such as:

●Severe, disabling pain that does not improve with strong pain medicines

●Severe pain in people who cannot take strong pain medicines

How do I prepare for vertebroplasty or kyphoplasty? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Blood tests

●Imaging tests – These might include X-rays, bone scan, CT scan, or MRI. They create pictures of the inside of the body.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before the procedure. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – You might be asked to take a bath or shower before you go in for your procedure. In some cases, you might also need to wash the area of your back with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during vertebroplasty or kyphoplasty? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Local – This type of anesthesia uses medicine to numb a small part of your body so you don't feel pain.

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●You will lie on your belly. The doctor will use fluoroscopy (a moving X-ray) to see inside your body.

●Vertebral compression fractures can be treated in 2 ways:

•Vertebroplasty – The doctor places a needle through the skin on the back into the vertebra. They check that the needle is in the correct place, then inject a special cement into the bone.

•Kyphoplasty – The doctor places a needle through the skin on the back into the vertebra. They place a special tube called a "catheter" through the needle. The catheter has a balloon on the end. When the balloon is in the vertebra, the doctor inflates it to make a hollow area in the bone, so it is no longer collapsed. Then, they take out the balloon and inject a special cement into the hollow area.

●The doctor might take a biopsy or small sample of the vertebrae during the procedure. This can help determine why the compression fracture developed.

●The bone cement will harden quickly and make the bone more stable. You might need to lie on your stomach for about 15 minutes as the cement hardens.

●The doctor will take more X-rays to make sure that the cement is in the correct place.

●They will cover the area with a clean bandage.

What happens after vertebroplasty or kyphoplasty? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people can go home the same day.

As you recover:

●Try to rest for the next day or so. Then, increase your activity slowly.

•Start with short walks around your home, and walk a little more each day.

•Avoid heavy lifting, sports, and swimming for at least a week or 2. (Your doctor or nurse will tell you exactly how long to avoid these or other activities.)

●Ice can help with pain and swelling. Put a cold gel pack, bag of ice, or bag of frozen vegetables on the injured area every 1 to 2 hours, for 15 minutes each time. Put a thin towel between the ice (or other cold object) and the skin.

●Take all of your medicines as instructed.

•Use a stool softener to help prevent constipation, if needed. This is a common problem if you take opioid pain medicines.

•You can also take non-prescription medicines to relieve pain, such as acetaminophen (sample brand name: Tylenol), ibuprofen (sample brand names: Advil, Motrin), or naproxen (sample brand name: Aleve). These can be used instead of opioids.

What are the risks of vertebroplasty or kyphoplasty? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Leaking of cement into the spine or other body tissues

●Infection

●Bleeding

●New fracture in the bone above or below the one that was treated

●Continuing to have pain

●Allergic reactions

What else should I know? — Before you go home, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

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Patient education: Vertebral compression fracture (The Basics)