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Each month we provide you with
a feature article. This article is authored by one of our
clinicians. Please direct all comments/questions to
info@cdaradiology.com.
Kyphoplasty - Feature 0907
It is estimated that osteoporosis causes 700,000 vertebral fractures
each year in the U.S. The primary consequence of osteoporosis is an
increased risk for fracture. The most common skeletal complication
of metastatic cancer is Vertebral compression fractures (VCFs). It
is estimated that 75,000 to 100,000 VCFs related to cancer occur
yearly in the US. Common tumors causing VCF are breast cancer, lung
cancer and prostate cancer.
 Vertebral
compression fractures have multiple acute and chronic consequences
including back pain, loss of mobility, decreased pulmonary function
and diminished quality of life. Deformity resulting from VCF worsens
these problems and can increase the risk of another fracture. The
Fracture Intervention Trial reported age-adjusted total mortality
increased 2-fold. Balloon kyphoplasty has been shown to benefit
patients with osteoporotic or cancer-induced VCF. Pain, functional
and radiographic outcomes of kyphoplasty have been shown to be
statistically superior to conventional non-surgical management. The
procedure has been shown to significantly improve patient quality of
life and ability to perform activities of daily living, as well as
reduce the number of days lost to bed rest.
Balloon kyphoplasty is a percutaneous procedure that can be
performed inpatient or outpatient with little or no postoperative
rehabilitation necessary. Patient satisfaction with the technique is
excellent with little, if any, procedural discomfort. Balloon
kyphoplasty has an excellent safety profile, with most studies
demonstrating a very low rate of procedure-related adverse events.
The radiologist assesses the fracture with imaging and examines the
patient to ensure appropriateness before the procedure begins.
Fluoroscopy (live x-ray) is use to place needles through the skin
which balloons are advanced into the fracture. The balloons are
inflated to the desired amount before PMMA (bone cement) in injected
to stabilize the fracture. The cement soon hardens and patients may
ambulate shortly thereafter.
As of April 26, 2007 approximately 310,000 patients and 365,000
spinal fractures worldwide have been treated with balloon
kyphoplasty.
Recovery is usually quick. Most patients experience immediate pain
relief after kyphoplasty. Most report that their pain is gone or
significantly better within 48 hours. Many people can resume their
normal daily activities immediately. The safety of kyphoplasty is
well documented. The bone cement used to stabilize the fractured
vertebrae has been shown to be safe through many years of use in
joint replacement surgeries and other orthopaedic procedures.
Indications for Kyphoplasty?
People who have suffered recent compressing fractures that are
causing them moderate to severe back pain with significant loss of
height, fracture lines extending to disc or the back wall of the
vertebral body, and fractures leading to a kyphosis (excessive
forward curving of the spine) are the best candidates for
kyphoplasty. In some cases, older fractures may be treated, but the
procedure is most successful if it is performed soon after the
fracture occurs.
Author
Randy Opp M.D.
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