Kyphoplasty: A New Treatment for Compression Fractures

by Steven Black, M.D.

Does your back hurt? Have you had a recent fall? Do you have osteoporosis? All of these questions could lead to having a vertebral compression fracture. A vertebral compression fracture occurs when the vertebral body fractures and collapses. According to the National Osteoporosis Foundation, the annual direct expenditure (hospital and nursing homes) is estimated at 17 billion dollars. The figure translates to $47 million a day. In the United States, approximately 150,000 patients are hospitalized every year with compression fractures resulting in a cost of 1.6 billion dollars. Most VCFs (vertebral compression fractures) are a result of osteoporosis, a disease that causes bones to become brittle and break easily. VCF can also occur as a result of certain types of tumors. Multiple compression fractures cause the spine to shorten and angle forward, resulting in a stooped posture. Kyphosis (forward curvature of the spine) makes it difficult to walk, reach for things or conduct daily activities. Other secondary effects of VCF are chronic back pain, loss of height, diminished appetite and difficulty sleeping. Over time, patients have increased risk of pulmonary problems.

Traditional treatment for VCF previous was limited to bedrest, bracing and management of pain, often with narcotics. Although appropriate in some circumstances, this does not address the deformity that can occur with multiple fractures. Balloon Kyphoplasty is a minimally invasive treatment that can stabilize the fracture and reduce back pain as well as restore height and spinal alignment.

In balloon Kyphoplasty, special high-pressure balloons are used to gently elevate the bone fragments in an attempt to return them to the correct position. All patients undergo appropriate testing prior to the procedure by having X-rays of the spine as well as either an MRI or nuclear medicine bone scan of the affected area. Conscious sedation and local anesthesia are utilized. Two needles are placed into the affected vertebra utilizing real-time X-ray guidance. When the needles are in position, both balloons are simultaneously inflated to raise the collapsed vertebra to its normal position. Once in correct position, the balloons are quickly deflated and a cavity in the bone is formed. The cavity is then filled with a special cement to support the surrounding bone and prevent further collapse. The cement hardens within 20 minutes; the entire procedure usually takes 45 minutes to an hour to perform. Most patients notice dramatic results and are pain-free by the next day.

It is important to treat VCF early. Just one VCF affects the distribution of weight along the spinal column. Misalignment can place more stress on the adjacent vertebrae, making them vulnerable for fracture. Fractures do not always come from a fall or other traumatic event. In osteoporosis patients, fractures can result from normal activities such as bending or reaching to pick up something.

Overall potential benefits of the procedure are a significant reduction in pain, significant improvement in quality of life, significant improvement in mobility and significant reduction in days per month a patient remains in bed.

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Steven Black, M.D., "Kyphoplasty: A new treatment for compression fractures," Woman's Way, 2005.