Operative Treatment Kyphoplasty

Although the majority of patients respond to nonoperative intervention, a small subset of patients develop worsening or chronic symptoms that affect their overall level of function. This fact has led to new advances in minimally invasive treatment methods for those patients who continue to have severe pain, discomfort, and disability following failure of nonoperative treatment for an osteoporotic compression fracture. The ideal minimally invasive intervention should be designed to not only treat the present pain and discomfort from the compressed vertebrae but also change the natural history of future compression of adjacent vertebrae from altered spinal biomechanics. This is the basis of a minimally invasive procedure known as kyphoplasty. This procedure involves the insertion of a bone tamp, that is, "pump," via a small cortical window within the vertebral body, allowing low-pressure injection of bone cement, that is, polymethylmethacrylate (PMMA) into a void created within an elevated compression fracture (Fig. 1). This process is designed to restore vertebral body height and provide immediate fracture stability. The desired restoration of spinal alignment and enhanced vertebral stability will theoretically render proper biomechanics, thereby reducing pain from altered sagittal alignment and potentially decreasing the incidence of future compression fractures. Vertebroplasty in contrast is defined as a minimally invasive procedure involving the high-pressure injection of bone cement (PMMA) through both pedicles or through other bony passageways into a vertebral body fracture to restore structural stability and therefore provide relief of pain. The difference between vertebroplasty and kyphoplasty is that kyphoplasty delivers a cement substance in a low pressure environment due to the void created by a balloon tamp intended to elevate the vertebral end plate to improve sagittal plane alignment.

FIGURE 1 A photograph of the inflatable bone tamp (pump) in the inflated position.

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Dealing With Back Pain

Dealing With Back Pain

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