Kyphoplasty

Kyphoplasty is similar to Vertebroplasty with a bit of variation in the technique used in injecting cement into the collapsed vertebral bones. Both methods aim at alleviating the pain caused by recent vertebral fracture which has stopped responding to conventional treatment of pain medication and bed rest. Kyphoplasty makes use of an inflatable balloon to create a cavity inside the collapsed vertebrae and is eventually filled with special bone cement to stabilize the fracture.

Percutaneous Balloon Kyphoplasty (BKP) is primarily used to treat vertebral compression fractures arising out of issues like osteoporosis, metastases or trauma.

Kyphoplasty is believed to be a superior procedure/ Interventional radiologic technique when compared to vertebroplasty as it claims the additional advantage of correcting the kyphosis (stooped back) and regaining the height lost, to some extent. A balloon (bone tamp) that can withstand high pressures is inserted and inflated to achieve the height. When the height and alignment of spine are corrected, the stress in the adjacent vertebral segments is reduced. Then there are lesser chances of adjacent vertebral fractures.

Taking the aid of image guided X-Ray machine, a hollow needle called Trocar is passed through the spinal muscle and positioned at the fractured back bone. This needle is inserted at an angle to avoid the spinal cord. Once the needle reaches the right position, the balloon is inflated to help gain the normal height of the vertebrae. Most often, two balloons are used to provide good support while lifting the collapsed vertebrae back to its normal position.

Inflated balloons, create a cavity/space inside vertebra while raising the collapsed bone. The balloons are slowly deflated and withdrawn. Bone cement (such as polymethylmethacrylate (PMMA)) is then carefully injected into the cavity under pressure filling the deeper side to the upper side of the cavity. Filling cement needs lot of care and skill as excess pressure or quantity may cause the cement to leak into adjacent areas. Cement hardens within 10 to 20 minutes forming an internal cast that holds the vertebral body. The needle is pulled off carefully before the cement hardens. The incision is closed with sterilized strips. The procedure takes about an hour to complete and is carried out both as inpatient or outpatient procedure. The patient is advised to take rest for a day even though he is discharged the same day after a brief period of observation. Some patients have reported Transient Hyperalgesia (abnormal sensitivity to pain) due to polymerization of the acrylic cement used in the procedure.

Interventional Radiology

A sub-specialty of radiology, Interventional radiology - IR has contributed significantly to medical developments in recent years. Patients are diagnosed and treated using minimally invasive imaging techniques such as X-ray, MRI and ultrasound for guidance. In addition to diagnosis, new treatment options are offered by techniques in Interventional radiology (also known as Surgical Radiology)- patients are treated with lesser risk and shorter hospital stays.

The advantage of IR procedures is that they can be used in almost every organ system - be it abdomen, central nervous system, chest, heart and vascular, musculoskeletal, genito-urinary and other organs and soft tissues.

Interventional Radiologists

Patient evaluation and management are provided by Interventional radiologists, who are doctors trained in radiology and in minimally invasive procedures, skilled in interpreting X rays, ultrasounds and CT and other imaging techniques. While surgery was the only available option for a number of conditions a few years back, these days the expertise of Interventional radiologists with imaging technique enables them to guide small catheters, that are only a few millimeters in diameter and guide wires through blood vessels or other organ pathways to treat many conditions. Diseases and conditions are diagnosed and treated percutaneously with minimally invasive procedures.

Benefits and uses of Interventional radiology

This is an imaging technique using cutting-edge equipment for accurate diagnosis and treatment, a minimally invasive procedure through a small nick in the skin, minimizing the patient's discomfort and recovery time. These days, there is hardly any area in hospital medicine where IR has not impacted patient management.

These procedures require only local anesthesia, and short stays at the hospital. Sick patients who are unfit to undergo surgery can also undergo these techniques. Recovery post IR procedure is less painful than when the patient undergoes surgical procedures.

These image guided medical procedures use CT, MRI, fluoroscopy and ultrasound to view targeted areas. This makes the vessels clearly visible under imaging. A thin catheter is used to deliver the contrast material into a particular blood vessel and shows the inside of the vessel allowing the radiologist to locate blockages. Some examples of interventional radiology procedures include:

• Angiography or Angioplasty
  
• Stent placement
  
• Control bleeding with Embolization
  
• Tumor embolization
  
• Vertebroplasty and Kyphoplasty
  
• Needle biopsies for different organs including lungs and thyroid gland
  
• Tumor ablation
  
• Breast biopsy by stereotactic or ultrasound techniques
  
• Uterine artery embolization
  
• Feeding tube placement
  
• Venous access catheter placement

Using Interventional radiology

By minimizing the physical trauma to the patient, non-surgical interventions also reduce infection rates and recovery time and shorten hospital stays.

• Blood vessel disease such as narrowing of arteries leading to restricted flow of blood
  
• Expanded arteries at risk of rupture and bleeding
  
• Bleeding or hemorrhage which is the most common vascular emergency treated by IR.
  
• Blood clots in the lung
  
• Dilated veins or varicose veins that most commonly occur in the legs but can occur in the pelvis and scrotum and can be treated by blocking the vein by heat treatment or using embolization techniques.
  
• Tumor therapies in liver intended to shrink or destroy them in their primary site.
  
• Kidney and other tumors by destructive therapies
  
• Uterine fibroids which cause heavy menstrual bleeding and pain caused by benign tumors called fibroids
  
• Kidney stones that can cause pain
  
• Infection and blockage in the kidney and gall stones, one of the most common upper abdominal disorders.

Vertebral Compression Fracture

Vertebral compression fracture occurs when a part in the vertebra collapses due to the compression of the bone in the spine. With age, vertebrae is weakened and loses its strength and leads to a condition called osteoporosis. Osteoporosis is a kind of bone loss that causes bones to break easily. Osteoporosis is the leading cause of vertebral compression fractures especially in the age group of 40 to 50 and above. Post menopausal women and men above the age of 65 years are at highest risk of suffering from vertebral compression fractures.

Apart from osteoporosis, there could be other reasons that lead to vertebral compression fractures. Young adults suffer from vertebral fractures due to spinal injuries during rigorous exercises, sports activities or accidents. These compression fractures normally heal within 8 to 10 weeks with good rest and pain medication. Vertebral compression fractures may also be attributed to cancer tumors associated with multiple myeloma and metastatic bone disease. In very rare cases, infection or Osteomyelitis of the vertebra also results in compression fractures.

Wedge fractures are the most common type of compression fractures wherein the front part of the vertebral body collapses and becomes wedge shaped. Other types of vertebral compression fractures include biconcave (collapse of central portion of vertebral body) crush fractures (collapse of entire vertebral body). These fractures happen most commonly in the thoracic spine (the middle portion of the spine), and lumbar spine (low back).

Symptoms of Vertebral compression fracture

Compression fractures caused by injuries produce sudden onset of sharp and throbbing pain. Fractures caused by osteoporosis may cause very mild to severe pain in the back. Normally the pain is intense in standing posture and there is respite when lying down.

Vertebral compression fractures also lead to kyphosis and loss of height especially with the fractures associated with osteoporosis.

Sometimes a severely fractured bone can impinge on the spinal cord. Thus, numbness or tingling in limbs or other areas of the body may occur if the spinal cord is affected. This can impair sensation in the areas supplied by the damaged nerve tissue.

Diagnosis

Doctor's evaluation of symptoms plays a major role in diagnosing compression fractures. Noting of complete history of the patient and clinical examination are necessary to determine the presence of vertebral compression fracture. When doctor suspects vertebral compression fracture, an x ray is ordered to confirm the diagnosis. If the X-Ray reveals a fracture, further imaging tests like CT scan and MRI are performed to rule out the involvement of spinal cord and also to understand the age of the fracture. A neurological exam may also be done to test for reflexes, muscle strength and sensory perception.

Treating Vertebral Compression Fracture

The conventional methods of treating vertebral compression fractures include pain medication, rest and bracing. While pain medication helps in alleviating the pain to some extent, back braces reduce the chance of further collapse of the bone, prevent deformity, and allow injuries to heal by taking the pressure off the fractured vertebral bone. Giving rest to the back by decreasing activities as much as possible helps in healing the fractures naturally and quickly.

There are also some minimally invasive methods used to treat vertebral fractures which are gaining popularity. Vertebroplasty and Kyphoplasty are two medical procedures that are increasingly being used to treat compression fractures. Here the fracture is treated by injecting a bone cement onto the collapsed bone through hollow needle. These are image-guided surgical procedures with minimum invasion that promise faster pain relief.

Further treatment also depends upon the underlying cause that is leading to vertebral fracture. If the osteoporosis is causing the bones to collapse, doctor may prescribe calcium and other bone strengthening supplements to avoid future compression fractures. If a tumor has caused compression fracture, more invasive surgery will be required remove sections of bone or tissue.