What is Thoracic Kyphoplasty?
Thoracic Kyphoplasty is an elective surgery in` the mid spine or thoracic region to repair a vertebral compression fracture causing severe back pain and a hunch back appearance condition called kyphosis.
What are the conditions indicating need for kyphoplasty in thoracic spine?
Of the several causes for back pain, kyphoplasty is indicated if the patient is suffering from vertebral body compressions, fractures, and osteoporosis.
Vertebral body compression fractures and osteoporosis occur due to weakening of the spine bones over time due to factors such as age, excessive weight bearing activities, trauma, and tumor or mass growth.
Osteoporosis is a disease in which the normal bone density, mass and strength is lost due to lack of calcium and minerals in the bone, causing porous bones. Often, this condition will lead to vertebral body fractures causing compression leading to severe pain, loss of strength and bending of the back.
Why is Kyphoplasty considered?
Kyphoplasty is a minimal invasive procedure that may be recommended after conservative measures such as medication and therapy have not resolved the symptoms. The procedure is highly necessary when the patient has multiple compression fractures. It is considered safe and effective in elderly patients, young adults, those who have respiratory disorders, and patients with non-healing compression fractures within a time period of 3 months.
Thoracic Kyphoplasty Contra-Indications
Kyphoplasty should not be done in the following conditions:
- If the compression fracture is uncomplicated & not causing any severe pain or deformity
- A tumor is present in the spinal cord
- Bone infection
- Hemorrhage or bleeding disorder
- Pain due to arthritis and disc herniation
Diagnosis of Thoracic Kyphoplasty
To rule out vertebral compression fractures, the following imaging tests may be advised:
- Spinal X rays
- CT scan
- MRI scan
In cases of osteoporosis confirmation, your doctor may ask to do Dual Energy X ray Absorptiometry or DEXA screening to measure bone density.
Steps Involved in Thoracic Kyphoplasty Surgery
PRE- OP EVALUATION:
- A neurosurgeon or an orthopedic surgeon will examine the patient for the physical findings.
- Pre-Op investigations such as blood tests, ECG, diagnostic imaging tests, chest x ray etc. may be done.
- Primary physician and anesthetist evaluation will be done for surgical fitness.
- Usually kyphoplasty is an outpatient procedure which takes about an hour for the procedure but time may extend if multiple fractures are present, so the patient should be admitted in the morning without eating or drinking anything for at least 6 hours prior to the procedure.
- The patient will lie down on the table in a prone position connected to vital monitors to record the patient’s blood pressure, oxygen saturation level, pulse rate, heart rate etc. Anesthesia will be administered accordingly to sedate the patient.
- A portable X ray instrument called Fluoroscopy or C-arm is used for imaging guidance; a hollow needle or tube called a trocar is inserted through the skin incision to reach the affected vertebral body.
- A balloon catheter is placed through the trocar by a device called a balloon tamp to reach the fractured vertebral body and inflated to produce a cavity inside and is then removed.
- Orthopedic cement is made up of an ingredient called Polymethylmethacrylate (PMMA)and is injected into the cavity. This bone cement hardens gradually, which will be confirmed by X ray images or a scan. The trocar is then removed; the incision is closed and a pressure bandage is applied over the area.
- The patient will be monitored and kept under observation for a few hours.
- Once the patient is completely awake and conscious, they will be allowed sips of water, followed by a soft diet after 6 hours.
- Avoid driving, smoking and drinking alcohol for at least a week following the procedure.
- You should resume your regular medicines along with any pain medications as prescribed for the procedure.
- Avoid heavy lifting and weight bearing activities for at least 6 weeks. You may gradually increase your routine activities with support and care.
- No need for post-op rehabilitation and physical therapy.
- Pain will subside within 3-5 days after the procedure and improved middle back strength and flexibility will be noticed.
- Minimally invasive procedure which does not require long skin incisions and stitches.
- Comparatively safe and effective.
- Improves patient’s quality of life by enabling flexible movements.
- Bleeding or hemorrhage
- Leakage of cement
- Rarely paralysis due to nerve damage
- Neural disturbances such as itching, numbness, tingling sensation over a period of time
- Allergic reactions
- Keep your follow up appointments with your doctor.
- If a high grade fever, chills, severe pain, or numbness is noticed please call your surgeon’s office.
- In case of any emergency conditions like seizures, loss of consciousness, or bleeding you should call 911 immediately.