22513 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance

Name of the Procedure:

Percutaneous Vertebral Augmentation
Common name: Kyphoplasty

Summary

Percutaneous vertebral augmentation, also known as kyphoplasty, is a minimally invasive procedure used to treat spinal compression fractures. It involves creating a small cavity in the fractured vertebra, inserting bone cement to stabilize the fracture, and possibly restoring the height of the vertebra. The procedure includes all imaging guidance needed to ensure precision.

Purpose

Medical Condition Addressed:

• Spinal compression fractures

Goals:

• Stabilize the fractured vertebra
• Alleviate pain
• Restore vertebral height if possible
• Improve mobility and quality of life

Indications

Symptoms and Conditions:

• Severe back pain due to a vertebral compression fracture
• Osteoporosis-related fractures
• Vertebral collapse caused by metastatic cancers

Patient Criteria:

• Patients with persistent pain not relieved by conservative management
• Patients with limited mobility due to vertebral fractures

Preparation

Instructions for the Patient:

• Fast for a certain period before the procedure (usually 6-8 hours)
• Adjust medications as instructed by the healthcare provider (e.g., stop blood thinners)
• Arrange for someone to drive you home

Diagnostic Tests:

• MRI or CT scan to assess the fracture
• Blood tests to check coagulation status and overall health

Procedure Description

1. Anesthesia and Positioning: The patient is given local anesthesia and possibly sedation. They lie face down on the procedure table.
2. Insertion: Using imaging guidance (fluoroscopy or CT), the surgeon inserts a needle into the fractured vertebra.
3. Cavity Creation: A balloon-like device (balloon kyphoplasty) is inserted through the needle and inflated to create a cavity and potentially restore vertebral height.
4. Bone Cement Injection: Bone cement is injected into the cavity to stabilize the fracture.
5. Closure: The needle is removed and the small puncture site is covered with a bandage.

Tools and Equipment:

• Fluoroscope or CT scanner
• Needles and cannulas
• Balloon device for cavity creation
• Bone cement

Anesthesia:

Local anesthesia and possibly mild sedation

Duration

The procedure typically takes about 1-2 hours.

Setting

• Outpatient clinic
• Hospital
• Surgical center

Personnel

• Interventional radiologist or spine surgeon
• Nurses
• Anesthesiologist (if sedation is involved)
• Radiology technician

Risks and Complications

Common Risks:

• Infection at the puncture site
• Bleeding or hematoma
• Cement leakage

Rare Risks:

• Nerve injury
• Allergic reaction to materials used

Management:

Most complications are manageable with proper medical care and follow-up.

Benefits

Expected Benefits:

• Immediate pain relief in many cases
• Stabilization of the vertebra
• Improved mobility and reduced need for pain medication

Timeline:

Benefits are often realized immediately or within a few days post-procedure.

Recovery

Post-Procedure Care:

• Rest on the day of the procedure
• Resume normal activities gradually
• Follow specific instructions about lifting and activity limitations

Recovery Time:

• Most patients can return to normal activities within a few days
• Follow-up appointment to monitor progress

Alternatives

Other Treatment Options:

• Conservative management (medications, physiotherapy)
• Vertebroplasty (similar but without cavity creation)
• Spinal fusion surgery

Pros and Cons:

• Conservative management has fewer immediate risks but may not provide quick pain relief.
• Vertebroplasty is less effective in restoring vertebral height.
• Spinal fusion is more invasive with a longer recovery time.

Patient Experience

During the Procedure:

• Minimal discomfort due to local anesthesia
• Some pressure or mild pain during needle insertion

After the Procedure:

• Mild soreness or discomfort at the puncture site
• Pain relief generally felt within a few days
• Instructions on activity limitations to prevent complications

Pain Management:

• Pain medications as needed
• Cold packs to relieve soreness at the puncture site

By adhering to these guidelines, patients typically experience a significant improvement in their symptoms and overall quality of life.