Interventional Radiology

Approximately 90% of kyphoplasty patients achieve moderate to significant pain relief. Improvement usually begins almost immediately, although it can take several days or longer. The complication rate is very low, 1% or less.

Kyphoplasty is a treatment for patients immobilized by the painful vertebral body compression fractures (VCFs) associated with osteoporosis or cancer.  Kyphoplasty is a minimally invasive procedure that can reduce compression fracture pain by a moderate to significant amount and additionally may stabilize the fracture, restore height and reduce deformity.

How is Kyphoplasty Performed?

Kyphoplasty is performed under conscious sedation (IV “twilight sleep”), or Monitored Anesthesia Care.  Only rarely is general anesthesia needed.  Using image guidance x-rays, two tiny incisions are made and a probe is placed into the vertebra where the fracture is located. A balloon, called a bone tamp, is inserted on each side. These balloons are then inflated until they expand to the desired height, then removed.  The spaces created by the balloons are then filled with PMMA, the same orthopedic cement used for many years to cement artificial joints such as hips, binding the fracture.  The cement hardens quickly, providing strength and stability to the vertebra, restoring height and relieving pain.  This has been described as “placing a cast on the inside of the bone”.

Kyphoplasty is an outpatient procedure that takes about an hour to perform, including the preparation time.  Recovery is bed rest for approximately two hours before discharge.  Patients are usually able to resume activity as tolerated soon afterwards.

Benefits of Kyphoplasty

Limitations in the traditional treatments of vertebral compression fractures have led to the refinement of such procedures as kyphoplasty. These procedures provide new options for compression fractures and are designed to relieve pain, reduce and stabilize fractures, reduce spinal deformity and stop the “downward spiral” of untreated osteoporosis.

Additional benefits of these procedures include:

  • short surgical time
  • only IV or local anesthesia required
  • can be performed on outpatient basis
  • patients can usually return to the prior level of activity
  • no bracing required

It remains essential that osteoporosis sufferers seek medical help and learn about ways to treat their condition as well as ways to prevent future problems.

  • FAQ

    Is the procedure safe? What are the complications and risks?

    Kyphoplasty is a safe procedure with few risks or complications. However, as with any medical procedure, the possibility of complications does exists. For example, patients with tumors in the spine or other serious medical conditions may be at a slightly higher risk of complications. The complications rate is about one percent (1%). However, serious complications have been reported in the literature including, very rarely, spinal cord injury resulting in paralysis and serious or fatal pulmonary embolism caused by cement traveling through veins to the lungs. Serious breathing problems during “twilight sleep” can occur, although the effect of the medicines can be reversed. Patients with significant lung problems or other serious conditions may be at higher risk for breathing complications. The medications are administered by experienced, critical-care trained Interventional Radiology Nurses, or by Certified Registered Nurse Anesthetists. The physicians of Raleigh Radiology who perform Kyphoplasty are well trained, experienced, and have an excellent safety record. We have been offering vertebroplasty and Kyphoplasty since 2001, performing almost 200 injections a year.

    A Registered Nurse will call before your procedure with instructions. You must have nothing to eat or drink the morning of the procedure unless instructed otherwise. Your necessary medications should be taken with small sips of water, or as directed by the RN who performs your pre-procedure call.

    Patients need to discontinue blood thinners such as Plavix or Coumadin for 5 to 7 days before the procedure. Be prepared to tell our medical staff about any allergies you have as well as all medications you take. Although the procedure doesn’t take long, you should plan to be at the hospital a half day for preparation and recovery times. Written instructions will be given prior to discharge. You need someone to drive you home. You should not drive for 24 hours. Limit lifting and activity for several days, even if you feel much better.

    We follow-up all outpatients by telephone. Follow-up office visits will be scheduled if necessary.

    How do I set up an appointment?

    Your physician or health care practitioner in most circumstances must refer you for consultation. A consultation can be scheduled through our Blue Ridge office at 919-781-1437.
    The procedure can usually be performed soon after the consultation, but not the same day. Rarely, patients known to us with recurrent fractures, the consultation and procedure may be done on the same day, but this is the exception.

    The Raleigh Radiology doctor will meet with you in our Blue Ridge or Cary office or at WakeMed Hospital to review your history and imaging studies, explain the procedure, and answer your questions. If you are a candidate and wish to proceed, your procedure will be scheduled at the earliest date for your convenience. It will be performed at WakeMed Hospital in the Interventional Radiology suite in the Department of Radiology. Our doctor MUST have your MRI (or CT/bone scan) at the time of consultation and the procedure. If your MRI was performed at WakeMed Hospital or in a Raleigh Radiology office, you do not need to obtain a copy of the study. If it was done at a non Raleigh Radiology facility, please be sure to bring the CD of the study.

    My fracture has been caused by cancer in the spine. Am I a candidate, and will Kyphoplasty interfere with radiation or chemotherapy treatments?

    One of the main indications for Kyphoplasty is painful VCFs caused by cancer. When cancer is present or suspected, the patient is carefully evaluated to make sure the procedure will likely be safe and effective. It will not interfere with your cancer treatments. It may alleviate pain faster than other therapies, but cannot replace them. A biopsy can be performed during the procedure without significant additional risk or time.

    Who will perform my Kyphoplasty, and what is an Interventional Radiologist?

    Raleigh Radiology has four Board-Certified, fellowship trained Interventional Radiologists who perform Kyphoplasty: Drs. Cynthia Payne, Mark Knelson, Satish Mathan, and Jason Harris.

    Interventional Radiologists (IR) undergo a minimum of six years of training after medical school, including a medical or surgical internship, a radiology residency, and an additional year of highly specialized training dedicated to Interventional Radiology.
    Interventional Radiology doctors specialize in the diagnosis and treatment of disease using modern imaging equipment such as high-resolution digital fluoroscopy, CT, and ultrasound. In fact, our specialty developed many widely used procedures such as vertebroplasty, angiography, angioplasty and stent placement, image guided biopsies, uterine artery embolization for fibroids, non-surgical therapy for brain aneurysms, among many other minimally invasive techniques that have benefited patients world-wide.

    Are the results durable? Will having bone cement injected increase my risk of a fracture in adjacent vertebra?

    The results tend to be durable. New pain usually indicates a new fracture in another vertebra. Without any form of treatment, a patient with a single fracture is at 5x-increased risk of another VCF. This risk increases significantly with each additional fracture. This is why is it important to diagnose and treat osteoporosis to reduce the risk of subsequent fractures. Multiple scientific studies over the past decade have not proven an increased risk of fracture in the adjacent vertebra following kyphoplasty or vertebroplasty. Some studies have shown a reduced fracture rate after treatment. The question remains under study. New fractures can be treated if they occur.

    How old can the fracture be for the procedure to still be effective?

    Studies document effectiveness is greatest in the first three months but is effective up to two years. However, the procedure can be effective in symptomatic fractures even years from the initial onset in carefully evaluated patients. The less collapsed the vertebra the better the outcome, but even severely collapsed vertebra usually respond well to injection.

    What is the difference between “vertebroplasty” and “Kyphoplasty”?

    During vertebroplasty, the cement is injected directly through the needle without first making a cavity by inflating a small balloon. Both procedures are safe and effective. Kyphoplasty is thought to offer the advantages of greater restoration of the normal shape of the vertebra, and less risk of cement escaping from the bone. Since the cavity was created by the balloon, the cement can be injected in a thicker “toothpaste” state than the thinner cement injected during vertebroplasty. Our physicians can perform both procedures, but use Kyphoplasty because of the greater control of cement injection and our perceived ability to better restore the vertebral body towards its normal shape.

    Will Medicare or my private insurance cover the cost?

    Medicare and most private insurers cover Kyphoplasty. Check with your insurer prior to the procedure if you have any concerns. Some private insurers require pre-authorization. Some may require six weeks of bed rest, bracing, and narcotic pain medications, even though these measures may be poorly tolerated, ineffective, and have complications. We continue to work with third party payers to educate them on the significant impact of VCFs and the need for earlier treatment in some patients. We monitor the outcomes of scientific studies that continue to prove the safety and effectiveness of Kyphoplasty

    What is Sacroplasty?

    Fractures of the sacrum (the broad bone at the base of the spine) can occur just like of the spine. While Sacroplasty is a newer procedure, it is based on the experience of treating vertebral fractures caused by osteoporosis and cancer. It involves the injection of a small amount of bone cement into the sacrum. Instead of MRI of the spine, MRI or CT of the sacrum is performed instead. Consultation, evaluation, and the day of the procedure are otherwise similar to Kyphoplasty patients.

    I don’t know whether I have osteoporosis. Does it matter?

    Yes. It is very important to know whether you have osteoporosis because of the increased risk for more fractures. Studies have shown patients with VCFs from osteoporosis have significantly decreased quality of life. Treatment can reduce the risk of fractures. Bone density scans are used to diagnosis osteoporosis. Please discuss this important screening study with your primary care doctor/provider. Many physicians provide this service in their office. If yours does not, we will be happy to assist in scheduling it and having the results sent to your doctor. Because the cement can interfere with the results, we encourage patients who need a bone density study to have it before Kyphoplasty.

    What is Kyphoplasty?

    Kyphoplasty is a minimally invasive procedure for the treatment of painful vertebral compression fractures (VCFs) caused by osteoporosis or cancer. Approximately 90% of patients achieve moderate to significant pain relief. Improvement usually begins almost immediately, although can take several days or longer. The complication rate is very low, 1% or less.

    Kyphoplasty is an outpatient procedure that takes about an hour to perform, including the preparation time. Recovery is bed rest for approximately two hours before discharge. Patients are usually able to resume activity as tolerated soon afterwards.
    During the procedure, one or two hollow core needles are inserted into the bone through approximately ¼ inch skin incisions using special x-ray equipment for guidance. Because osteoporosis results in softening of the bones, insertion is usually accomplished without patient discomfort using local anesthetic and intravenous (IV) conscious sedation or “twilight sleep.”

    A balloon is placed through the needle, inflated to create a small cavity, and then removed. Surgical bone cement is injected to stabilize the bone. This is the same cement used by orthopedic surgeons for decades to secure artificial joints. Usually it takes less than a teaspoon of cement to be effective. The cement hardens rapidly. This procedure has been likened to placing a cast inside the bone.

    Kyphoplasty was developed in the U.S. in 1998. Hundreds of thousands of patients have been treated worldwide.

    How do I know if I am a candidate for Kyphoplasty?

    You must have a confirmed diagnosis of vertebral compression fracture (VCF) to be seen in consultation. Many, if not most, VCFs will heal within six weeks without intervention. People who have suffered compression fractures within the past three months and are experiencing moderate to severe back pain are the best candidates. Older fractures may be treated. Patients with severe compression deformities may be treated, although it is desirable to treat before severe collapse occurs. Patients with acute VCFs requiring hospitalization for pain control are treated as soon as possible, with proven benefits in reducing hospital length of stay and rehabilitation time.

    Kyphoplasty is not used to treat back pain from causes such as ruptured disc, spinal stenosis, pinched nerve, or arthritis. Kyphoplasty is not used to prevent compression fractures or to treat fractures that are causing minimal or no pain.
    We use these general guidelines to decide when to treat outpatients:
    pain rated as 4 or greater on the Visual Analog Scale of 0 – 10
    pain not controlled with narcotics or drugs poorly tolerated
    pain significantly limiting Activities of Daily Living (ADLs)
    For new patients, referrals must come through the physician or provider who is treating or has diagnosed your VCF. Patients often have other medical conditions. Determining if you are a candidate requires an understanding of your overall medical condition including medications. This is best accomplished by our doctors reviewing the medical records provided by your doctor.

    Patients must have a MRI scan, preferably before the consultation visit. Plain x-rays do not ‘tell the story’ of compression fractures. They can miss early fractures with minimal loss of height, although these are just as painful as fractures with obvious collapse. In patients with multiple fractures, plain x-rays cannot always identify healed old fractures from acute painful fractures. (More than one fracture can be treated during a session.)
    The MRI scan should ideally include a special sequence called “STIR” (short tau inversion recovery) to best identify the involved level(s). At Raleigh Radiology, a STIR sequence is routinely performed on patients if given the indication of compression fracture. For patients who cannot have a MRI because of a pacemaker, brain aneurysm clip, or other reason, a nuclear medicine bone scan and/or spine CT may be requested instead.

  • Exam Prep

    Nothing to eat or drink after midnight. If you are on blood pressure medications, you  may take your AM dose with a small sip of water, otherwise hold off on taking your other medications. Discontinue taking Aspirin, Coumadin, or Plavix 5 days prior to procedure. Make sure driver is available post procedure.