22514 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, also known as Kyphoplasty.

Summary

Percutaneous vertebral augmentation (PVA) is a minimally invasive procedure designed to stabilize and reinforce fractured vertebrae. It involves creating a cavity in the fractured vertebra using a mechanical device and then injecting bone cement to stabilize the bone. Imaging guidance ensures precise placement of tools and materials.

Purpose

PVA is primarily performed to treat:

• Painful vertebral compression fractures (VCFs) often caused by osteoporosis, spinal tumors, or trauma. The goals are to:
• Reduce pain.
• Stabilize the vertebra.
• Restore some of the lost vertebral height.
• Improve mobility and quality of life.

Indications

• Severe back pain caused by vertebral compression fractures.
• Osteoporotic fractures.
• Fractures due to metastatic bone disease.
• Ineffectiveness of conservative treatments (e.g., pain medications, rest).
• Loss of height or spinal deformity due to fractures.

Preparation

• Patients may need to fast for several hours before the procedure.
• Medication adjustments, especially blood thinners, might be necessary.
• Pre-procedure imaging, such as MRI or CT scans, to assess the exact location and condition of the vertebrae.

Procedure Description

1. Anesthesia: The patient receives local anesthesia, possibly with mild sedation.
2. Positioning and Imaging: The patient is positioned face down, and imaging guidance (fluoroscopy or CT) is used to locate the fractured vertebra.
3. Cavity Creation: A small incision is made, and a needle (trocar) is inserted into the vertebral body.
4. Mechanical Device: A balloon catheter is inserted through the needle and inflated to create a cavity and restore vertebral height.
5. Bone Cement Injection: The balloon is removed, and bone cement is injected into the cavity to stabilize the fracture.
6. Completion: The cement hardens, the tools are removed, and the incision is closed.

Duration

The procedure typically lasts about 1 to 2 hours.

Setting

PVA is performed in a hospital operating room or an outpatient surgical center.

Personnel

• Interventional radiologist, orthopedic surgeon, or neurosurgeon.
• Nursing staff.
• Anesthesiologist or nurse anesthetist (if sedation is used).

Risks and Complications

• Infection.
• Bleeding.
• Cement leakage, potentially leading to nerve damage or embolism.
• Allergic reaction to anesthesia or materials used.
• Rarely, worsening of pain or new fracture at other spinal levels.

Benefits

• Rapid and significant pain relief.
• Stabilization of the fractured vertebra.
• Improved mobility and quality of life. Benefits are often realized within a few days to a week post-procedure.

Recovery

• Patients typically remain under observation for a few hours post-procedure.
• Most can go home the same day or the day after.
• Mild soreness at the incision site is common.
• Avoid heavy lifting and strenuous activity for a few weeks.
• Follow-up appointments to monitor recovery and evaluate the success of the procedure.

Alternatives

• Conservative treatments (pain medication, bracing, physical therapy).
• Vertebroplasty (similar to PVA but without balloon cavity creation).
• Open surgical interventions (more invasive with longer recovery).

## Pros and Cons:

• PVA offers quicker pain relief and shorter recovery time compared to conservative treatments and surgery.
• Vertebroplasty is less complex but might not restore vertebral height as effectively.

Patient Experience

• During the procedure, the patient might feel pressure but should not experience pain due to anesthesia.
• Post-procedure soreness is typical at the incision site but resolves within a few days.
• Pain management includes over-the-counter or prescription pain medications as needed.
• Patients often experience significant pain relief and improved mobility shortly after the procedure.