Kyphoplasty

KEY FACTS

Terminology

• Vertebral fracture reduction via bipedicular balloon inflation followed by polymethylmethacrylate (PMMA) cement augmentation

Preprocedure

• Carefully determine correct level

• STIR MR is most sensitive for vertebral edema

• Ensure level of pain is consistent with acutely fractured vertebra on imaging

Procedure

• Angle C-arm toward side of pedicle to be accessed

  • Must have clear view of pedicle cortex

• Lateral fluoroscopy is essential in determining needle depth

• Needle tip in vertebra should allow inflated balloon to be centrally placed in hemivertebra

• Sudden decrease in pressure and heterogeneous contrast extravasation indicates balloon rupture

Post Procedure

• Expectation: Significant decrease in pain following procedure

  • Some patients will develop periprocedural pain requiring narcotics ± muscle relaxants

• Problems: Fracture at additional/adjacent levels

  • Risk appears increased with PMMA cement extravasation into disc space

Outcomes

• Most feared complications

  • Spinal cord puncture during needle placement

  • Spinal cord compression by hematoma or cement extravasation

TERMINOLOGY