Kyphoplasty, Vertebroplasty, Vertebral Augmentation

Anesthesia Implications

Position: Prone, arms extended and flexed (“superman”)
Time: 30-60 min (short)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: Preference
Lead: Yes

Patient will be induced and turned prone.

Have lead ready. 1-2 C-arms will be utilized to find the correct position.

Quick procedure – some practitioners opt to use paralytics to ensure the patient remains motionless (general anesthetic), while others just keep the patient deep.

The MAC approach – some suggest that MAC sedation can be used for this procedure. The patient positions themselves and then sedation is given. A sample approach: Versed 1-2 mg (age dependent). Glycopyrrolate 0.2 mg to decrease secretions from ketamine. Fentanyl 50 mcg and Precedex 8-12 mcg for positioning. Goggles and O2 on the patient just prior to positioning themselves. Then give Ketamine 20-50 mg (20 mg bolus and then 10 mg each dose as needed up to 50 mg). Propofol infusion is typically titrated between 75-150 mcg/kg/min.

Prone Position (general considerations): Maintain cervical neutrality. Keep IV’s out of the antecubital space. The patients arms are typically flexed, which will kink the IV. Eye protection should be used as the prone position heightens the risk of corneal abrasion and/or traction on the globe (which can result in blindness). Check the patients eyes/ears/nose regularly throughout the case to ensure they are free of pressure. Positioning of the leads is typically high on the posterior and posterolateral back (somewhere free of pressure and out of surgical borders). Keep your connections and tubing where you’ll have fast access.

Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.

This procedure is designed to give some reinforcement to a collapsing vertebral column. The procedure is very often done for those who have a compression fracture or simply a weakened vertebral column. If not corrected, the collapsing bone can lead to chronic pain, kyphosis or dowager’s hump, and loss of height.

Both a vertebroplasty and a kyphoplasty are collectively called vertebral augmentations. Both involve injection of bone cement into the spinal column. In a kyphoplasty, however, balloons are used to expand the space in the vertebral column prior to injecting the bone cement.