Vertebral Augmentation (Vertebroplasty and Kyphoplasty)

Vertebral Augmentation procedures are those where cement is placed into the bone of the spine. Vertebroplasty and Kyphoplasty are the two most common types of these augmentation procedures. They are typically performed for acute painful spine fractures related to osteoporosis, but may also be performed for fractures related to metastatic cancer, myeloma, or benign aggressive hemangioma involving the spine. We perform these procedures on outpatients or inpatients under conscious sedation and typically without general anesthesia. One or two large needles are placed into the fractured vertebral body. In general, Kyphoplasty requires that 2 needles are placed into the fracture level being treated while only one may be placed in Vertebroplasty. These needles are placed from the skin with fluoroscopic (x-ray) guidance while you lie on your stomach on a special x-ray table. 

In Kyphoplasty, a balloon is placed through each needle and then inflated within the fractured bone to create a cavity and hopefully to restore some of the height loss of that vertebral body by the compression fracture. If height is improved, the alignment of the spine may also be improved. The balloons are deflated and removed, and bone cement is then placed into the cavities and along the fracture lines through the same needles with very close fluoroscopic control. 

In Vertebroplasty, the cement is injected directly into the fractured vertebral body and fracture without any balloon inflation. 

Both procedures work very well as treatment for recent painful fractures. These vertebral augmentation procedures have similar potential complications which include: 

1. BLEEDING. All needle procedures have a risk of bleeding. Bleeding around the spine can push on nerve roots or the spinal cord. Patients have had to undergo emergency surgery to relieve pressure on the nerve roots and spinal cord because of bleeding after spinal needle procedures.  Blood thinners such as Coumadin will be stopped prior to the procedure, and routine laboratory blood work will be done to evaluate bleeding risk.
2. INFECTION. Any needle through the skin can introduce infection. Infection of the spinal bone is an extremely rare complication called osteomyelitis.  Sterile technique will be used to minimize the risk, and additionally we will give you intravenous (IV) antibiotics just prior to the procedure to decrease the risk as well. 
3. NEW FRACTURE. The large needles placed can cause a new fracture of a portion of the spine or of an adjacent rib, which can cause new symptoms. A fracture fragment may potentially displace away from the spine and push on nerve roots or the spinal cord. This rarely occurs and even more rarely requires surgery. 
4. LEAKAGE OF CEMENT. Cement may leak out of the vertebral body where it is injected.  A small amount of cement leakage is not uncommon and typically does not cause symptoms.  Usually the leak is into the tissues next to the bone or the adjacent disc.  Cement may leak into the neural foramen (openings next to spine where nerves travel) and push on the nerves, or may leak into the spinal canal and push on the spinal cord or nerves. This pressure on the nerves or spinal cord could cause symptoms that might require emergent surgery.  
5. LEAKAGE OF CEMENT INTO VEINS AND PULMONARY EMBOLUS. The cement can also potentially leak into the nearby veins of the spine and then travel in the veins to the lungs as an embolus of cement. This process is similar to how blood clots from the legs may travel to the lungs.  Although leakage into a vein is not uncommon, pulmonary embolus is rare. 
6. RESPIRATORY COMPROMISE. There have been a few deaths associated with multilevel fractures treated with Vertebroplasty and Kyphoplasty, which are felt to be the result of fat emboli to the lungs from the vertebral bone and cement. Patients with severe underlying lung disease such as COPD/emphysema may be at higher risk for this complication. No more than 2 levels at one time will be treated in these patients or even only one level at a time. 

If you have any questions, please feel free to ask the physician performing the procedure prior to signing the consent.