Kyphoplasty and Vertebral Compression Fractures

July 6, 2018

1. What is Osteoporosis?  How is it diagnosed?  What are the potential complications?  What treatments are available?

Osteoporosis is a disease that affects women more than men and is most often seen after the age of 50 in postmenopausal females.  Risk factors for osteoporosis include a diet lacking in Calcium and Vitamin-D, certain medications such as corticosteroids, excessive alcohol consumption, and smoking. There is no cure for this bone disease that causes thinning of bones and can make them weak enough to results in fractures (breaks) of the hip, wrist, and spine.  Worldwide, 1 in 3 women and 1 in 8 men over the age of 50 has osteoporosis

If you have this disease, or are at risk for it, you can learn more about its prevention, possible consequences, and treatment from your physician or orthopaedic specialist.   A specialized test known as a DEXA (Dual Energy X-ray Absorption) Bone Densitometry scan can be performed to determine the mineralization of your bone.  This is a non-invasive test that takes specialized X-rays of your wrist, spine, and hip and then determined the density of your bone.  There are three values that may be obtained from this study including normal, osteopenia (slight loss of bone density), and osteoporosis.  In additions, you doctor should consider getting a blood test looking for the amount of Vitamin-D in your system to see if this may be a cause for decreased bone density.

Treatment includes a variety of medications and behavior modification.  This includes low level weight bearing exercise, a diet rich in calcium and Vitamin-D, and cessation of smoking.  Medications include over the counter vitamin supplements, prescription medications (Fosamax, Actonel, Boniva), and hormone replacement.

1. What is a vertebral compression fracture?

Osteoporosis is the leading cause of vertebral compression fractures. This type of spine fracture may occur in the mid (thoracic) or  lower (lumbar) back and can lead to a condition known as kyphosis, when the back becomes rounded or hunched because of the collapse of the front part of the vertebrae.  In addition to the deformity, the fracture can cause a significant amount of pain and prevent the routine activities of daily living. Spinal fractures are the most common fracture; there are 700,000 spinal fractures per year in the U.S of only which one-third are diagnosed.

Vertebral compression fractures can be a debilitating and painful condition leading to a chronic painful condition and eventually causing other disturbances such as poor appetite, inability to breathe deeply, depression, loss of independence, and sleep difficulties.  With one fracture, there is a very high risk for developing another fracture.  In addition if ambulation is affected, there is a greater risk of falling and sustaining other injuries such as breaks of the hip or wrist.

In the past, these fractures used to be treated with bed rest, pain medication, bracing, and large surgeries all of which have potential complications and do not  necessarily increase function.  These all have a long recovery time.  Recently a new minimally invasive surgical procedure may prevent the need for the above if you are considered a candidate for the procedure.

I had a patient recently that had a minimal fall and sustained an osteoporotic vertebral compression fracture.  He was admitted to the hospital and was placed on a lot of pain medication.  He subsequently had to be placed on home oxygen for breathing difficulties secondary to his emphysema and the pain of the fracture.  The medication did not help him that much and he did not tolerate the brace well.  He was subsequently referred to me and underwent Kyphoplasty, the minimally invasive fracture stabilization, and woke up from Anesthesia not requiring any oxygen and had complete pain relief.  He is now two years after his procedure and doing extremely well.  He resumed his normal activities within four weeks.

1. What is Kyphosis and what is Kyphoplasty?

Kyphosis is a normal alignment that is found in the thoracic spine (middle between the neck and lower back) when it is between 20-40 degrees.  However, beyond 40 degrees, this may be due to a deformity of the spine.  Kyphosis in the elderly results from osteoporosis as the thin bones may crack (fracture) resulting in a deformity.  Extreme Kyphosis can lead to a hunched back or a “dowager’s hump”.

Kyphon (www.kyphon.com), a company from Sunnyvale, California introduced a new technology in 2000 which allows physicians to restore the normal alignment of the vertebral body and create a cavity in the vertebral body in which bone cement is placed after the balloons are removed.  This procedure (kyphoplasty) allows for restoration of anatomy as well as relief of painful compression fractures.  The procedure is being performed in internationally and from the time of introduction till March 2006, over 245,000 fractures have been treated worldwide.

Balloon Kyphoplasty is a minimally invasive treatment option for patients with spinal fractures that provides:

– Significant reduction of pain

– Significant increase in mobility

– Significant improvement in quality of life

1. What does the procedure involve?

The procedure takes approximately 30 minutes and is done in a minimally invasive way without the use of large incisions or blood loss.  The procedure may be done under general anesthesia or local anesthesia with sedation depending on your medical conditions.  Two small incisions are made and a pathway is created to the vertebral body.  Through these tubes, the KyphX Xpander Inflatable Bone tamp (balloons) are inserted and are slowly inflated to restore the alignment of the bone and create a space in the vertebral body for placement of the cement after the balloon has been removed. You may have an overnight stay in the hospital for pain control, antibiotics, and physical therapy.  You may experience some immediate pain relief and may or may not require the use of pain medications.

1. What are the indications for the procedure?

The indications for this procedure is for pain as a result of an Osteoporotic vertebral compression fracture that is either acute or subacute if there is a failure of conservative treatment such as bracing and various medications.  Your doctor will need to evaluate you and determine if you are a candidate for the surgical procedure.  It will be determined by your history, physical examination, overall medical condition, type and location of the fracture, and various radiology studies including X-ray, MRI, and /or Bone Scan if you are a candidate for the procedure.  Other indications include pain and fractures from diseases such as Multiple Myeloma or Metastatic Cancer.