Kyphoplasty

Promising Treatment (Kyphoplasty) Relieves Pain from Spine Fractures

   With the development of kyphoplasty, treatment of compression fractures is changing. Patients no longer need to put up with fracture pain and progressive hunching of the spine thanks to this new technique. The kyphoplasty technique involves a new technology whereby an osteoporotic compression fracture can be treated, pain relieved, the lost bone height restored, and the fracture immediately stabilized with the injection of bone cement. This is all done through two ½" incisions on each side of the effected vertebra. The technique involves the use of x-ray equipment to insert working tools into the collapsed vertebra. An inflatable bone tamp or expander is then placed into the fractured vertebra on each side and very slowly, the balloons are inflated, lifting up the fractured portion of the vertebra to a more normal height. The balloons are deflated and cement is slowly injected.

   Results from this technique have shown excellent restoration of fractures which are less than four to six months old, and better than 90% success at reducing pain associated with the broken vertebra.

   Complications from this procedure have been very few and have been primarily related to patients who have been on blood thinner medications. Potential complications also include cement leaking out of the vertebra and into inappropriate areas. To date, these have been very rare with kyphoplasty.

Who Would Benefit From Kyphoplasty?

   Patients who have experienced a recent vertebral compression fracture due to osteoporosis can benefit from kyphoplasty. Fractures are best treated and have the best chance at being restored to their original height when the fractures are less than four months old. For patients who are on chronic Prednisone or steroids, even older fractures can be treated and restored to full height.

Case History

   An 82-year-old woman presented to the office with recent onset of severe back pain. X-rays showed a fractured vertebra in the mid back. Examination of the patient showed she was beginning to stoop forward. Pushing along the spine revealed one area of maximum tenderness, which correlated, with the x-ray findings of the fracture. She was sent for an MRI scan, which confirmed the new fracture. No other significant abnormalities were found.

   This patient was a very active woman who had been married more than 50 years to the same man. The two of them enjoyed walking, traveling, shopping and socializing with friends. The patient was not able to perform any of her daily activities because of the pain.

   The patient elected to proceed with kyphoplasty. After this one-hour surgery, the patient noted immediate relief of pain and was "able to roll over in bed now without yelling out in pain". She returned to the office two weeks later for a check up and reported being back to full activity. She was very happy with her results. The x-rays showed excellent restoration of the fractured vertebra and immediate stability of the broken bone.

Other Surgical Options for Spinal Fractures

   Vertebroplasty is a procedure where cement is injected into the fractured vertebra without any attempt at correction of the collapsed bone. The pain relief is similar to kyphoplasty, though vertebroplasty has a higher complication rate from extruded cement going in places it was not meant to go. This is due to vertebroplasty requiring high pressures to inject very liquid cement into the bone. In stark contrast, kyphoplasty uses thickened cement injected slowly to fill the void created by the balloon and the cement technique is therefore much safer than vertebroplasty. Because of problems with cement filling and the inability to reduce the fracture deformity, vertebroplasty is clearly a second choice to kyphoplasty.

   When there is a severe collapse of several vertebra in a row causing the patient to be stooped forward, kyphoplasty will not help. These fractures are often too old or too severe to inject with cement. The only other option is to consider major surgery to straighten the spine and hold it in place with spinal instrumentation (screws, hooks and rods). Such an undertaking is only advisable after all other options have been exhausted and when there is significant pain and functional disability.

The Future

   We predict that kyphoplasty will become the standard treatment for patients who experience new osteoporosis related fractures in their spine. This technique has been shown to eliminate both the deformity and the pain from the fracture. It is all done through a small ½" incision on each side of the vertebra. Following surgery, these incisions are covered with Band-Aids and the patient is able to get up and walk immediately. There is no down time. This exciting procedure has changed the way we care for patients with osteoporotic compression fractures.