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 The balloons are slowly deflated and withdrawn.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.

Scoliosis

Scoliosis refers to an abnormal curving of the spine. While everyone has a natural curve to the spine, scoliosis indicates an unnatural curve. When the spine appears to bend forward, it is known as Kyphosis. When the spine appears to bend backward, it is referred to as Lordosis. In scoliosis, the person develops additional curve and the bones of the spine twist on each other.

Infantile Scoliosis: Noticed in children 3 years and younger.

Juvenile Scoliosis: Noticed in children from 4 to 10 years.

Adolescent Scoliosis: Noticed in children from 11 to 18 years.

Congenital Scoliosis: This is present from birth and is a result of improper formation of the baby's ribs and spine.

Neuromuscular Scoliosis: Medical conditions like cerebral palsy, muscular dystrophy, spina bifida, and polio lead to this kind of scoliosis. Abnormal development of spinal bones can also lead to this type of scoliosis.

Functional Scoliosis is caused by an abnormality located elsewhere in the body, such as difference in leg length.

Symptoms of Scoliosis

The person has a noticeable pelvic tilt and one shoulder might be higher than the other. Backache or lower back pain is felt. Sometimes the unnatural curve of the spine makes it difficult for the proper functioning of the heart and lungs. This can result in chest pain and shortness of breath.

Diagnosis tests such as spinal curve measurement, x-ray, CT scan and MRI of the spine are undertaken to check for structural and temporary spinal curve. A neurological examination of the patient is also done to check for muscle weakness, numbness and abnormal reflexes.

Treating Scoliosis

Treatment for scoliosis depends on the nature and degree of curvature as well as age of the patient. Infantile idiopathic scoliosis often improves without treatment. Juvenile scoliosis is often the kind that gets worse over time. A brace is often suggested to prevent worsening of the spinal curve. This is ideal when the patient is still growing and the curve is moderate. Low profile brace or Thoracolumbosacral Orthosis TLSO is one that is contoured to the body shape. It is worn under the clothes and fits under the arms and around the rib cage and back and hips. This works best for curvature of the upper spine.

Milwaukee Brace is a full-torso brace that is worn when the condition is more severe and has a neck ring for resting the chin and back of the head. Schroth Exercises are often recommended to help the patient deal with the condition. It encompasses a set of stretching, breathing and strengthening exercises that can be incorporated into your daily lifestyle. Corrective surgery is done when scoliosis is getting severe. A metal rod might be inserted to fuse two or more bones.

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.