KYPHOPLASTY & VERTEBROPLASTY​

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Kyphoplasty and vertebroplasty are minimally invasive procedures used to treat vertebral compression fractures, which are most commonly caused by osteoporosis, cancer, or injury. These procedures aim to reduce pain, stabilize the fracture, and restore some or all of the lost vertebral body height due to the compression fracture.

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1. Vertebroplasty: In this procedure, a doctor injects a special cement mixture into the fractured bone. The doctor uses imaging guidance to guide a thin needle containing the special cement through the skin and into the vertebral body. Once the needle is in the correct position, the doctor injects the cement into the fractured bone. The cement hardens quickly, stabilizing the fracture and providing immediate pain relief in many cases.

2. Kyphoplasty: This procedure is similar to vertebroplasty but involves an additional step. Before injecting the bone cement, the doctor inserts a small, inflatable balloon into the vertebral body. The balloon is then inflated to create a cavity. Once the cavity is created, the balloon is deflated and removed, and the cement is injected into the cavity. The aim of this procedure is not only to relieve pain and stabilize the fracture but also to restore the height and angle of kyphosis of the vertebral body.

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Both vertebroplasty and kyphoplasty are collectively called vertebral augmentations.

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                                         Anesthetic Implications for  Kyphoplasty & Vertebroplasty

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Anesthesia type: General anesthesia, TIVA, MAC, local anesthesia with sedation

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Airway: ETT

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Preoperative:

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• Performed under fluoroscopic or CT guidance

• Have lead aprons and thyroid shields available

• Elderly patients with comorbidities

• Assess patient's airway and history of sleep apnea

• Prone positioning may result in a significant fall in cardiac output

• Eye protection for general cases

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Intraoperative:

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• Trocar is passed percutaneously into the affected vertebral body 

• The passage of the trocar through the periosteum of the vertebral body is painful

• Position: Prone with arms extended and flexed (“Superman position”)

• Duration: 30-60 minutes

• Maintain cervical neutrality

• Be mindful of close proximity of the iliac vessels, inferior vena cava, and descending aorta to the thoracolumbar vertebral bodies

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Postoperative:

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• Pain management

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Complications:

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• Loss of airway

• Infection

• Bleeding

• Increased back pain

• Nerve damage

• Complications related to the bone cement

• Cement leakage into surrounding areas

• Pulmonary emboli

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Sources:

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Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.

 

Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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