Kyphoplasty is a percutaneous, minimally invasive method of treating vertebral compression fractures in which conservative treatment after 4 weeks did not give results.
The standard technique involves the use of two introducer needles and two straight balloon catheters via a bilateral trans or extrapedicular route followed by the application of bone cement. With the development of navigating (manageable) technology, the same results can be achieved unilaterally.
Anesthesia and procedure
After local anesthesia in the region of the procedure, an 11 G introducer is placed transpedicularly into the vertebra and a preferential route for the high-pressure (700 psi) articulating balloon is made using a navigating osteotome. Articulating balloons have a larger volume (up to 30 mm) than flat balloons (up to 20 mm) used in the bilateral technique and therefore can leave a bilateral impression along the entire vertebral body with a unilateral approach. By using a high-volume balloon that gives a bilateral impression and injecting PMMA (polymethyl methacrylate) cement into the created cavity, it is possible to restore the height of the compressed vertebra. The application of cement under low pressure into the created cavity reduces the risk of cement extravasation.
Kyphoplasty is a treatment procedure whose goal is to restore strength, firmness and height in a compression-fractured vertebra, and it is possible to do the above with a unilateral or bilateral approach without a significant difference in the results of these parameters.
Recovery
Studies have shown the advantages of unilateral kyphoplasty compared to bilateral in shortening the duration of the procedure, shortening the duration of exposure to radiation, reducing the potential risk caused by cannulation of the vertebra, and lower cost of the procedure. Also, benefit was shown in terms of better recovery, less use of drugs, less risk of mortality, less need for hospital treatment and use of analgesic therapy in all patients with compression fractures treated with vertebroplasty and kyphoplasty methods compared to conservatively treated patients.