Kyphoplasty

[foxtrot]

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Anyone have any good articles/advice for beginners doing kyphoplasties in the pain world? I am just now starting to incorporate this procedure into my practice.

 

[Jcm800]

studies are out there, and they are the same...

only advice i have is the simple stuff.

1) dont blow up the balloon to hard, turn it slowly and do it live, and watch the pressure come down. Dont listen to rep that it can take up to 400 psi, there is no need for that.

2) dont blow the balloon up to much. If you are worried about retropulsion and spillage of cement, make a small cavity, fill it, then wait a bit, then fill a little more till you see some cement interdigitate. on AP make it spreads and meets midline (assumption is you are doing bipedicular, i have done unipedicular kyphos, though not recommened)

3) and dont get lulled into the false sense of safety that this ridiculous cavity allegedly produces. im not sure how crushing all this bone to the side then filling it in really makes sense, but nonetheless, i see more extravasation of cement with kyphos then i do with vertebroplasty, whatever

4) check the thickness of every prefilled canula you are handed. The techs will fill it and hand it to you, make sure it is thick enough.

5) Its never thick enough

6) quit wasting your time doing kyphos and just do vertebroplasty initially with two trocars, and inject very slowly under vision and your results will be as good, if not better and with a lot less useless moving parts, and the wasted time of a hospital. although i do like my kyphon rep, i am starting to do less and less and just go with vertebroplasty 7-8/10.

i dont know if any of that is anymore than my quirks, but there ya go...

 

[hyperalgesia]

Enjoy it when your kypho rep says, "Wow look at that reduction Doc!", when in fact there is NO reduction whatsoever. I also like my rep but I feel the benefit of kypho vs vertebroplasty is minimal, if it exists at all. I read a study that says the "average" fracture reduction with kyphoplasty is 40%. Maybe, since I don't do kyphos immediately and try conservative tx first, I certainly don't ever see that kind of reduction.

 

[Jcm800]

Enjoy it when your kypho rep says, "Wow look at that reduction Doc!", when in fact there is NO reduction whatsoever. I also like my rep but I feel the benefit of kypho vs vertebroplasty is minimal, if it exists at all. I read a study that says the "average" fracture reduction with kyphoplasty is 40%. Maybe, since I don't do kyphos immediately and try conservative tx first, I certainly don't ever see that kind of reduction.

my rep doesnt comment on the height restoration because he knows that i dont care about it, and i always cite th study that 8 weeks out, the height restoration is not even there anymore...height restoration has no effect on pain, and moreover it has never shown any functional improvement. its a selling tactic, that hey know works on some guys...

 

[SleepIsGood]

Any of you guys use the Carefusion/Card Health Vplasty? We switched over to them from Stryker at myplace. Their system is pretty neat, sort of rules out the need for kyphos...what do you all think?

 

[foxtrot]

A couple of questions:
1) Do most of you guys do venograms before injecting the cement?
2) Are you guys adding antibiotics to the PMMA mix to ward off infections?

 

[lobelsteve]

I only do vertebroplasty. 2g Ancef pre-op. IV, sedation ready. Office based procedure.
AP/Lat fluoroscopy, unipedicular for almost 2 years. Nothing in the cement other than the liquid that comes in the kit. I'll be playing with Stryker's new viscosity stuff soon.

 

[mid|ine]

2) Are you guys adding antibiotics to the PMMA mix to ward off infections?

I did tons in my fellowship (>100 vert and kyphos) and the IR doc I did them with is a leading expert, and no, no ABx in the mix.

 

[clubdeac]

Any of you guys use the Carefusion/Card Health Vplasty? We switched over to them from Stryker at myplace. Their system is pretty neat, sort of rules out the need for kyphos...what do you all think?

Since being in practice I've only used Carefusion with the curved needle. It obviates the bipedicular approach but sometimes you can't get the curved needle to punch though the bone if it's not osteoporotic. I only did 5 in fellowship so I don't have much to compare to.

On a side note, I got two referrals for "fresh" compression fractures on xray. Well, I got MRIs prior to each and both patients had >60% cord compression from either retropulsion or disc/osteophyte complex. I sent both to neurosurgery for decompression. I assume everyone on here only does vplasty after getting an MR, right?

 

[Jcm800]

Since being in practice I've only used Carefusion with the curved needle. It obviates the bipedicular approach but sometimes you can't get the curved needle to punch though the bone if it's not osteoporotic. I only did 5 in fellowship so I don't have much to compare to.

On a side note, I got two referrals for "fresh" compression fractures on xray. Well, I got MRIs prior to each and both patients had >60% cord compression from either retropulsion or disc/osteophyte complex. I sent both to neurosurgery for decompression. I assume everyone on here only does vplasty after getting an MR, right?[/QUOTE]


or CT, depending if the cant get an MRI...

 

[hyperalgesia]

or CT, depending if the cant get an MRI...

Same here and haven't had a problem yet. But what do you think of this article for kyphoplasty? The authors feel you should get both CT and MRI every time.
http://www.orthosupersite.com/view.aspx?rid=35997

 

[Jcm800]

Same here and haven't had a problem yet. But what do you think of this article for kyphoplasty? The authors feel you should get both CT and MRI every time.
http://www.orthosupersite.com/view.aspx?rid=35997

what a waste. Bet they own an imaging center that has BOTH CT and MRI....

 

[Ligament]

I did tons in my fellowship (>100 vert and kyphos) and the IR doc I did them with is a leading expert, and no, no ABx in the mix.

WOW, thats great! Which fellowship is this? Sounds like MDAnderson????

 

[SleepIsGood]

WOW, thats great! Which fellowship is this? Sounds like MDAnderson????

not necessarily. Places in the east coast as well.

 

[ParaVert]

We didn't rotate through IR for kypho experience - our attendings (Anes, PM&R, Neuro do them. My guess is that this is MGH, the fellows there rotate through IR with Dr. Hirsch. That guy is a cement machine.

BTW Midline, how's Suheil?

 

[hyperalgesia]

We didn't rotate through IR for kypho experience - our attendings (Anes, PM&R, Neuro do them. My guess is that this is MGH, the fellows there rotate through IR with Dr. Hirsch. That guy is a cement machine.

BTW Midline, how's Suheil?

Cement machine... Is that a compliment?

 

[mid|ine]

Correct, MGH and Dr. Hirsch