Patient Selection

The selection criteria for balloon kyphoplasty are similar but not equivalent to those for PV (see Chapter 14). As with PV, the patient selection process includes obtaining a detailed history and physical examination. The patient's symptoms need to be linked to the VCF. Evaluation of the patient's films [radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and bone scans] should correlate symptoms with the fracture location and image characteristics.

Balloon kyphoplasty has been used to treat osteoporotic VCFs. It may also be used in patients with vertebral body involvement from neo-plastic disease such as plasmocytoma or multiple myeloma. The likelihood of restoring vertebral body height depends largely on the density of the bone and the acuity of the fracture. Fractures treated within 1 to 3 weeks of the event are much less likely to have experienced substantial healing and provide the best opportunity for height restoration.

The exclusion criteria for balloon kyphoplasty are also very similar to those used for PV and include (1) VCFs that are not painful or that are not the primary source of pain, (2) the presence of osteomyelitis or systemic infection, (3) retropulsed bone fragments, or (4) an epidural extension of tumor. The latter two factors must be considered because balloon inflation for the KP procedure could force material into the spinal canal, causing cord compression.

There are also relative contraindications to KP. First, there must be sufficient residual height for the instruments used with kyphoplasty to be inserted into the compressed vertebral body. Thus, although PV may be performed in a severely compressed vertebral body, KP of the same vertebral body may not be technically feasible (Figure 18.2). Second, small pedicles may also be a limiting technical factor because the instruments used for KP are somewhat larger than those for PV. When the pedicles appear to be too small to accommodate the KP instruments, a parapedicular approach can be utilized. Kyphoplasty can be performed safely from L5 to T7 in most patients.13

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Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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