Over 1 1/2-million fractures occur
in this country each year as a result
of osteoporosis. Although hip fractures
receive the majority of attention,
vertebral compression fractures (spine
fractures) are far more common. There
are 300,000 hip fractures that occur
each year, compared to 700,000 spine
fractures that occur each year. That
equates to about one spine fracture
every 45 seconds.
The vertebra is the bony part of the
spine between the discs, that provide
structural support of the spine, and
protects the spinal cord. These vertebra
are made of a hard cortical shell,
while the inside is made of cancellous
bone, which has a honeycomb appearance
and is important in the production
of various blood cells. This honeycomb
bone is very strong when we are younger,
but as we get older and osteoporosis
develops, this bone becomes very weak
and, and can fracture.
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Normal
Bone |
Osteoporotic
Bone |
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Chronic fractures are very small
fractures that occur over many years.
They generally do not cause any
pain, and a responsible for the
loss in height and the hump that
older people develop on the back
part of their spine above the shoulder
blades. An acute fracture on the
other hand, is a sudden fracture,
which usually results in the sudden
onset of excruciating back pain.
It may occur as the result of some
activity, or even after something
as simple as coughing or sneezing.
Although most older patients develop
some back pain at some point in
their lives, often as a result of
arthritis, spine fractures cause
sudden pain that is very severe
unlike any pain that they had before.
The fracture is often diagnosed
by their doctor using history, physical
examination, and a variety of radiographic
studies such as an x-ray, an MRI
or a bone scan.
Often however, these fractures continue
to be painful, despite narcotic
medications, braces, and even bed
rest. Additionally, there are significant
downsides to prolonged bed rest,
including loss of as much is 2%
of the patient's bone mass per week.
Furthermore, elderly patients with
severe back pain became afraid to
leave the house, both because of
the pain, and because of the fear
of having another fracture if they
go out and fall again. Consequently,
they become less active, became
more dependent on others, and often
become depressed. Moreover, these
fractures often reduce a person's
ability to expand their lungs, which
can lead to a significant increase
in lung problems, including death.
Finally, even in those patients
whose pain does improve with medical
management, it is often very time-consuming
(it may take several months to heal),
and the spine often heals in a deformed
position. As one can see, the conventional
treatment of vertebral compression
fractures has been less than ideal.
Generally speaking, the goal of
treatment for any fracture in the
body is to restore the normal anatomy,
stabilize the fracture, reduce
a patient’s pain, and get
the patient out of bed and walking
as soon as possible. While open
surgery and stabilization generally
achieves these goals in most parts
of the body, in the spine that
surgery can be very extensive and
risky. As such, patients were relegated
to medical management, which often
failed to relieve patient’s
pain and had many side effects.
Recently, a new procedure has been
gaining popularity as a minimally
invasive treatment of compression
fractures of the spine. Two small
needles are inserted through two
small nicks in the skin, and then
a small working channel is passed
into the fractured vertebra. At
this point, often a bone biopsy
is performed, since occasionally
these fractures can occur as the
result of cancer. Then, two very
strong balloons are inserted. These
balloons are then inflated, which
can reduce the fracture, and restore
the spinal alignment to a more normal
position.
The balloons are then deflated,
leaving a small cavity in the fractured
vertebra. This cavity is then filled
slowly and carefully with medical
grade cement. The medical grade
cement hardens in just a few minutes,
providing strength and stability
to the spine.
There are no big incisions and no
blood loss. The risks of the procedure
are very low. Patients are asked
to get out of bed just a few hours
after the procedure. Studies have
shown that approximately nine out
of 10 patients get 90% or better
pain relief, and much of that relief
is almost immediate. There are also
no restrictions of activity after
the procedure. In the United States,
over 70,000 fractures have already
been treated.
Kyphoplasty is a new and exciting
treatment option for patients suffering
debilitating back pain from a spine
fracture due to osteoporosis. The
procedure is done through the skin,
does not involve any big incisions
or significant blood loss, provides
immediate stabilization of the spine
fracture, can restore the spinal
alignment, and provides almost immediate
and long-lasting pain relief. Kyphoplasty,
however, is not a treatment for
osteoporosis. It is simply a treatment
for the pain that results from the
spine fracture. Patients are encouraged
to see their doctor to discuss medical
treatment options for osteoporosis
to prevent further spine fractures.
For more information about kyphoplasty,
please visit http://www.kyphon.com/
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