Kyphoplasty: A New Treatment for Osteoporotic Spinal Fractures

Osteoporosis is an age related bone disorder characterized by "weak bone" due to decrease in bone mass. This affects 28 million people in the United States. Approximately 1.5 million new fractures each year are related to osteoporosis. The most common bone to fracture due to osteoporosis is the spine. There are 700,000 new osteoporotic spine compression fractures per year as compared to 300,000 new hip fractures per year. Osteoporosis is more common in women. 5% of women 50 years old and 25% of women 80 years old have at least one osteoporotic spine fracture. Once a patient has one spine fracture they are 5 times more likely to develop another osteoporotic spine fracture.

The diagnosis of these osteoporotic spine fractures can be challenging. The pain usually starts suddenly with little or no injury. The initial work up is with a physical exam by a physician. There is usually pain over the fractured vertebra with touch. The next step is a plain x-ray of the painful part of the spine. If the area of tenderness of your back is at the same level of the fractured vertebrae, then the pain is most likely coming from the fracture.

Treatment for these compression fractures usually consists of bed rest and narcotic medication. The problem associated with bed rest is that you can lose 4% of your bone mass with 4 weeks of bed rest. This decreased activity can worsen the osteoporosis. Narcotic medication does not always relieve the pain and can be sedating increasing the risk of falls. The majority of these fractures heal with time. The pain decreases usually after 6 weeks. However, some patients can have continued pain from these fractures. This pain can be quite debilitating.

Previously, the treatment for patients who continued to have pain from their vertebral fractures consisted of a major surgery to place screws and rods to fuse the spine. This had a high complication rate due to the frail health of the elderly population. Within, the past several years there has been a new development in the minimally invasive treatment of these fractures. This procedure is known as "Kyphoplasty".

Kyphoplasty is a technique which involves the use of inflatable tamps "balloons" to reduce the fracture. These balloons are placed through small 5mm incisions in the patient's back. The balloons are inflated to attempt to reduce the fracture. The balloons are then removed and orthopedic cement (similar to that used to fix hip replacements) is injected into the "space" in the fractured vertebral body. This cement hardens in minutes. In most patients, the improvement in pain is immediate and no brace is needed after kyphoplasty. This procedure is usually done under a general anesthetic and most patients are discharged the same day.

The ideal candidate for this procedure is a patient who has an osteoporotic compression fracture that occurred less than 8-12 weeks prior to consideration of kyphoplasty. By addressing the fracture earlier, there is a better chance of "reducing" the fracture. The patient also needs to have pain over the fractured vertebra. If the patient is considering a kyphoplasty, an MRI (Magnetic Resonance Imaging) of the spine needs to be done to check to see if the fracture is not completely healed. If a patient meets all these criteria, they have a very good chance of significantly improving or eliminating their back pain from the compression fracture.

The spine physicians at Panorama Orthopedics were selected to be part of the initial study group several years ago. Since then, we have used this procedure successfully. We have also taught physicians this technique throughout the United States and Europe.