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Learn about interventional radiology
Massachusetts General Hospital Imaging provides kyphoplasty, a minimally invasive, image-guided treatment for back pain caused by vertebral fractures, on the Mass General main campus in Boston. Performed by specially trained radiologists using real-time image guidance, interventional-radiology procedures such as kyphoplasty often require smaller incisions, have fewer risks of complication, and take less recovery time than traditional surgery.
Kyphoplasty in depth
What is a vertebral fracture?
A vertebral (spine) fracture occurs when the usual rectangular shape of the bone becomes compressed and distorted, causing pain and in some cases, disability. These compression fractures, which may involve the collapse of one or more vertebrae in the spine, are a common symptom and result of osteoporosis. They are also sometimes caused by trauma or cancer.
Kyphoplasty is a non-surgical spinal procedure used to treat painful, progressive vertebral fractures. Kyphoplasty involves the use of a device called a balloon tamp to restore the height and shape of the vertebral body. This is followed by application of bone cement to strengthen the vertebra.
Kyphoplasty is an example of an interventional radiology procedure. In such procedures, specially trained radiologists use real-time imaging technology to guide them as they perform a treatment that provides pain relief or addresses the cause of a disease. Interventional procedures are "minimally invasive," which means that they use smaller incisions, have fewer risks of complication, and require less recovery time than traditional surgery. In many cases, our doctors helped to pioneer the interventional treatments that we offer.
The interventional radiologists who perform procedures at Mass General Imaging are specialists in the area of the body and the condition under treatment, as well as the procedure itself. In addition to the training that all radiologists receive, these specialists have additional education, plus extensive real-world experience. In many cases, our doctors helped to pioneer many of the interventional treatments that we offer.
Our team of interventional radiologists and nurse practitioners coordinates a patient's complete care—from imaging evaluation to post-procedure followup—maintaining a high level of communication with the patient throughout the process. In addition, Mass General Imaging works in close coordination with experts from across Mass General when necessary.
When should I consider kyphoplasty?
Candidates for kyphoplasty include men and women who have chronic back pain (at least six weeks) and debilitation due to vertebral body fracture or disc herniation. Patients often have limited mobility and cannot perform routine daily activities, such as bathing, dressing and walking. Kyphoplasty is usually performed after conservative treatments (bed rest, back brace, oral pain medications) have failed. Most patients are elderly (average age 70 years), but younger patients with osteoporosis, due to metabolic disorders or long-term steroid treatment, may also benefit from kyphoplasty. Some patients with vertebral destruction from malignant tumors are also candidates.
Not all patients with vertebral fracture are appropriate candidates for kyphoplasty. Careful screening is critical to ensure that symptoms are due to the vertebral fracture, rather than another problem. It is not enough that patients have a vertebral fracture, since a healed fracture should not cause pain. Thus, it is necessary to exclude other potential explanations for back pain, such as disc herniation, severe arthritis, and compression of the spinal cord or nerve roots.
What should I expect BEFORE kyphoplasty?
All patients must be evaluated by one of our staff prior to kyphoplasty. Sometimes a telephone interview is sufficient, but usually you must be seen in person. The evaluation includes a directed history and physical examination and blood tests. Often, patients can point to a single painful spot. If the location of pain matches the level of fracture seen on standard radiographs (x-rays), then there is a good chance that kyphoplasty will be successful.
At our initial evaluation, you should bring any imaging studies that were not performed at Massachusetts General Hospital. It is essential that all patients have recent plain radiographs and MRI. If MRI cannot be performed (due to a cardiac pacemaker, for example), CT scan is necessary. Some patients may need examination under fluoroscopy or bone scan.
What should I expect DURING kyphoplasty?
Kyphoplasty is a non-surgical procedure that is performed using state-of-the-art imaging (fluoroscopic) guidance. The procedure is usually performed in the morning. You must be able to lie face down for one to two hours. Our team of professionals will make you as comfortable as possible. An intravenous line will be placed in your arm to decrease anxiety and control pain. Intravenous antibiotics are also administered to prevent infection.
After using a local anesthetic to numb the skin and muscle, the doctor positions a needle in the collapsed vertebral body. Under careful image guidance, small balloons are directed into the bone. The balloons are then inflated in small increments until certain endpoints are reached. The balloons are then deflated and removed. The acrylic bone cement is then placed into the spaces created by the balloons.
What should I expect AFTER kyphoplasty?
Patients are often treated under general anesthesia and may stay overnight in the hospital.
You may experience dull aching at the needle puncture site during the first 24 hours following the procedure. An ice-pack can help with this discomfort. Tylenol or non-steroidal anti-inflammatory medication is usually sufficient. Narcotic pain medications should be minimized. You should call us if you develop severe or increasing chest or back pain, fever, or neurological symptoms.
We call patients at home approximately 48 hours following kyphoplasty, and again at seven days. Otherwise, you receive follow-up care from your referring or primary care physicians. To hasten recovery and regain satisfactory levels of activity, you may benefit from physical therapy or short-term back bracing.
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