Kyphoplasty—minimally invasive vertebral compression fracture repair - Home Study Program

AORN Journal,  Nov, 2003  by Kelley Erickson,  Susan Baker,  Jason Smith

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The article "Kyphoplasty--Minimally invasive vertebral compression fracture repair" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Nov 30, 2006.

Complete the examination answer sheet and learner evaluation found on pages 779-780 and mail with appropriate fee to

BEHAVIORAL OBJECTIVES

After reading and studying the article on minimally invasive repair of vertebral compression fractures, perioperative nurses will be able to

1. describe the anatomy involved with vertebral compression fractures,

2. identify the pathophysiology of vertebral compression fractures,

3. discuss conservative treatment options available to patients who have vertebral compression fractures,

4. describe the perioperative experience of patients undergoing kyphoplasty for treatment of vertebral compression fractures, and

5. explain potential complications of the kyphoplasty procedure.

The spinal column is composed of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, the bony sacrum, and the coccyx. A side view of a normal spinal column demonstrates reciprocal curves, beginning with cervical lordosis and then lumbar lordosis (Figure 1). A typical vertebra contains the vertebral body, which supports 80% of the impact applied to the spine (Figure 2). (1) Surrounding the vertebral body is cortical bone with cancellous (ie, spongy) bone in the interior. This structure provides a very vascular matrix of hematopoietic tissue (ie, blood forming cells), which allows significant storage of a variety of blood cells and other nutrients. (1)

[FIGURES 1-2 OMITTED]

PATHOPHYSIOLOGY

Osteoporosis is caused by loss of bone calcium. This weakens the bone structure, making it porous and brittle. (2) Existing bone is broken down before new bone can replace it, resulting in decreased bone density and strength. This combination places patients at significantly higher risk for vertebral compression fractures. These fractures increase spine kyphosis, bringing the center of gravity forward and away from the bending axis of the spine. (3) Traditionally, vertebral compression fractures cause sudden back pain attributed to little or no trauma. (1) The top of the vertebral body collapses. Typically more collapse occurs in front, thus producing a wedged vertebrae with shortened height (Figure 3). (2)

[FIGURE 3 OMITTED]

Ultimately, this deformity and its resultant postural change may lead to serious health problems, which include, but are not limited to

* decreased mobility,

* decreased quality of life,

* difficulty sleeping,

* increased pulmonary disorders, and

* 23% higher mortality rate. (2)

Patients with thoracic and lumbar fractures have reduced pulmonary function because of 6% to 9% loss of forced vital capacity that results from decreased thoracic space created by the deformity. Patients' height loss also restricts movement. (2) Studies have demonstrated that patients with an initial vertebral compression fracture have a five-fold increased risk for subsequent fractures. (1)

INCIDENCE

Worldwide, osteoporosis affects one in three women and one in eight men older than age 50. Nationally, 44 million people are at risk for osteoporosis. (4) Approximately 1.5 million fragility fractures occur in the United States annually, 700,000 of which are spinal fractures. Two-thirds of these fragility fractures occur in women. (4)

Risk factors for osteoporosis include, but are not limited to,

* being postmenopausal,

* consuming caffeine,

* drinking alcohol,

* having an eating disorder,

* genetics,

* race (ie, Caucasian and Asian ancestry), and

* smoking. (4)

Additionally, older people and those who have a history of osteomyelitis and cancer have a higher rate of vertebral compression fracture occurrence, (5)

Although it is not curable, there are four steps that if taken together may help prevent osteoporosis.

* Consume a balanced diet rich in calcium and vitamin D.

* Regularly perform weight-bearing exercises.

* Maintain a healthy lifestyle. Do not smoke, and avoid excessive alcohol intake.

* Have bone density testing performed regularly, and take medications as ordered by health care providers.

Osteoporotic fractures cost $13.3 billion annually. (3) Vertebral compression fractures cost approximately $1.5 billion and result in 150,000 patient hospitalizations per year. On average, vertebral compression fractures necessitate an eight-day hospital stay. (3)

SYMPTOMS

In acute events, patients experience a sudden onset of back pain, which may or may not be the result of trauma. If left untreated, the vertebra heals in a deformed position, which ultimately may lead to a spinal deformity (ie, Dowager's hump), protruding abdomen, decrease in overall patient height, and chronic back pain. (6) Additionally, patients suffer from a center of balance shift and increased muscle fatigue, which ultimately increases their risk of falling and incurring additional vertebral compression fractures. (6)