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• Balloon Kyphoplasty

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Balloon Kyphoplasty

Painful vertebral body fractures (VBFs) and tumours can now be treated quickly, safely, and effectively by a new treatment called balloon kyphoplasty. In patients with osteoporosis VBFs can occur after simply coughing or turning awkwardly. They can even occur spontaneously. They normally cause severe and disabling back pain that requires large doses of very strong painkillers. They also cause spinal deformity that can lead to a loss of height and the typical “Dowager’s Hump” sometimes seen in elderly women. VBF sufferers are at high risk of further falls and fragility fractures such as at the hip and wrist. Metastatic spinal tumours and haematological malignancies such as multiple myeloma can also cause severe spinal pain.

The conventional treatment for VBFs is bed rest and analgesia. Bed rest should be avoided in osteoporotic patients as it contributes to further bone loss and muscle atrophy, which predisposes patients to further falls and fractures. The pain is often so severe that strong opioid analgesics such as morphine are required. These usually cause constipation and can cause drowsiness, nausea, and vomiting. Often patients cannot tolerate the analgesics they require in order to control their pain.

Balloon kyphoplasty is a refinement of an earlier procedure called vertebroplasty. Both treat the pain from VBFs and spinal tumours by injecting special bone cement into the vertebral bodies through needles that are inserted through the skin into the vertebral bodies under continuous x-ray guidance. Both procedures are highly successful at treating the pain. Patients can often stop all pain medication within hours and in some cases can even go home on the day of treatment.

Balloon kyphoplasty differs from vertebroplasty in that it uses balloons to create a cavity inside the vertebral body which means that there is much less chance of cement leakage into important structures. The balloons can also help to reduce the fracture, or return it to its pre-fracture shape, helping to reduce the deformity.

Both procedures are extremely safe with very little chance of any serious complication. At the Bone Health Unit we have specialists who were amongst the first to perform balloon kyphoplasty in the UK. All have been fully trained and have considerable experience in both procedures.

Who is suitable?

If you have a spinal tumour your oncologist will generally refer you for treatment but if you have a malignancy and want investigation and treatment we will be happy to organise everything for you.

If you have osteoporosis and think you may have had a VBF please call the Bone Health Centre. You will be seen by one of the Consultant Rheumatologists who will assess, diagnose and then recommend the most appropriate line of treatment.

The best results are achieved if the fractures are treated as early as possible, but they can also be successfully treated many months after the fracture.

What is involved?

First of all you will need to be fully assessed. This involves proper imaging of your spine both with X-Rays and Magnetic Resonance Imaging (MRI), and occasionally also Computed tomography (CT). You will need a full blood work up and a general medical check-up. If you have not had a bone density scan then we will require you to have one of these done.

The procedure is generally carried out under a short and light general anaesthetic. It is not a painful procedure but the anaesthetic is used as you could find it uncomfortable to lie still in the right position for us to do the procedure.

The procedure will be carried out in either an operating theatre or the X-Ray department. Two special needles are inserted under constant X-Ray screening through the skin of your back into the vertebral body. Once in place we will insert balloons through these needles and inflate them with X-Ray contrast liquid so we can see them expand under X-Ray. Once we have inflated the balloons to the right amount we will then remove them and inject special bone cement into the cavities formed by the balloons.

This bone cement fully hardens in less than twenty minutes and the procedure is over as soon as we have injected it. This means that as soon as we have finished injecting the cement you can be woken from the anaesthetic and as soon as you are fully awake you will be allowed to walk.

We have seen many patients who have been able to go home just a few hours after having had a balloon kyphoplasty or vertebroplasty but we normally keep patients in for one night.

Most patients find a significant reduction in their pain immediately and many are able to stop all strong painkillers within a day of the procedure.

What are the risks?

First of all you should know that both vertebroplasty and balloon kyphoplasty are extremely safe and it is rare to get a complication that requires treatment. However all medical procedures, no matter how minor, carry a theoretical risk of infection or bleeding. There is a risk that the needles may touch or damage a structure outside the vertebral body. This is very unlikely as they are inserted under constant screening and all our surgeons are fully trained and experienced.

The most likely complication is that some cement may leak out of the vertebral body. This is important if it leaks onto a nerve or towards the spinal cord. It may also get into the bloodstream. Both of these are very unlikely due to our experience and our use of constant X-Ray screening.