The article "Kyphoplasty--Minimally...

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

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

unbroken the examination answer sheet and learner evaluation erect on pages 779-780 and mail with appropriate fief to

BEHAVIORAL OBJECTIVES

After reading and studying the article onward minimally invasive repair of vertebral compression fractures, perioperative feed at the breasts 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 file 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 round pillar demonstrates reciprocal curves, beginning with cervical lordosis and then lumbar lordosis (Figure 1) A typical vertebra contains the vertebral visible form [i]or[/i] frame which supports 80% of the impact applied to the spine (Figure 2) (1) Surrounding the vertebral visible form [i]or[/i] frame is cortical bone with cancellous (ie, spongy) bone in the interior. This manner of making provides a very vascular matrix of hematopoietic tissue (ie, life-current forming cells), which allows significant storage of a variety of life-blood cells and other nutrients. (1)

[FIGURES 1-2 OMITTED]

PATHOPHYSIOLOGY

Osteoporosis is caused by dint of loss of bone calcium. This weakens the bone texture making it porous and brittle. (2) Existing bone is enfeebled down before new bone can replace it, resulting in decreased bone density and solidity 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 abrupt back pain attributed to little or no trauma. (1) The top of the vertebral material part collapses. Typically more collapse appears 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 point to be solved [i]or[/i] settleds 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 reduc pulmonary function because of 6% to 9% los of forced vital capacity that originates from decreased thoracic space created according to the deformity. Patients' height los also restricts change (2) Studies have demonstrated that patients with an initial vertebral compression fracture have a five-fold increased risk for following fractures. (1)

INCIDENCE

Worldwide, osteoporosis affects single in kind in three women and single in kind in eight men older than age 50 Nationally, 44 million the public are at risk for osteoporosis. (4) Approximately 15 million fragility fractures present itself in the United States annually, 700000 of which are spinal fractures. Two-thirds of these fragility fractures present itself in women. (4)

Risk factors for osteoporosis include, nevertheless 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 clan and those who have a history of osteomyelitis and cancer have a higher rate of vertebral compression fracture proceeding (5)

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

* expend a balanced diet rich in calcium and vitamin D

* Regularly perform weight-bearing exercises.

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

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

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

SYMPTOMS

In acute marked occurrences patients experience a sudden attack of back pain, which may or may not be the come 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 go through from a center of balance shift and increased muscle fatigue, which ultimately increases their risk of falling and incurring additional vertebral compression fractures. (6)