Revolutionary Technique Can Repair Spinal Fractures and Relieve Pain
This report was reviewed for medical and scientific accuracy by Michael Divon, MD , Director of OB/GYN, Lenox Hill Hospital, New York.
Imagine a momentary lapse when you come home from the food store and set a heavy bag of groceries down on the kitchen table without looking. Crunch! Horrified, you lift the bag and are pained to discover you have just crushed the fine bone china teacup your grandmother gave you years ago. You spend the next three hours with a tube of "Krazy" glue, carefully cementing the pieces of that prized cup back together. When you are done, the graceful shape has been largely restored and with a sigh of relief you place the cup in the china cabinet where it belongs, resolved to never disturb it again.
Now imagine surgeons are busy doing exactly the same thing, performing the infinitely more delicate task of gluing pieces of fractured spine back together in patients-most of them likely to be somebody's grandmother-whose vertebrae has collapsed because of osteoporosis. This time, the sighs of relief come from the patients, because as the deformed vertebrae is returned to its original shape, the excruciating pain of a compression fracture almost instantly disappears.
The procedure is called kyphoplasty, and while it is definitely the product of imagination and creativity-notably Dr. Joseph Lane's, a Professor of Orthopedic Surgery at Cornell University, and Chief of Metabolic Bone Disease at the Hospital for Special Surgery in New York-it is also a revolutionary new surgical treatment for patients who suffer osteoporotic spinal fractures.
Osteoporosis is most prevalent in women and usually occurs after menopause, when the body's supply of bone-protecting estrogen falls off sharply. Unless osteoporosis is treated, bones throughout the body thin and become brittle. In the spine, vertebrae can spontaneously collapse, sometimes "silently" (no pain), but usually with unrelenting pain that forces patients to walk bent over or sleep in a chair because they cannot lay flat in their beds. Kyphoplasty is the first technique ever developed that allows the repair of vertebral fractures and corrects the deformity. The procedure is done by needle injection, not by more traditional open-surgical techniques.
Reminiscent of the well-known balloon angioplasty technique used to open clogged coronary arteries, surgeons first insert the needle into an area of the fractured vertebrae called the pedicle. Through the needle, a tiny balloon is then delivered into the cavity of the fracture and slowly inflated with a saline (salt water) solution. The inflating balloon acts as a miniature hydraulic lift, gradually setting the collapsed bone back into place. Once the vertebrae has been restored to its normal shape, surgeons remove the balloon and through the same needle, inject the surgical glue under low pressure, fixing the bone permanently in place.
"It takes just seven minutes for the glue to set," said Dr. Lane, "but the vertebrae is repaired and returned to normal shape for the rest of the patient's life."
Called "polymethymethancrylate," the special surgical glue has been used during hip replacement procedures since 1968. "Based on that experience, it seems clear this cement will hold almost indefinitely, since it has held up in those patients with no complications for over 30 years. We are also investigating switching to a cement containing hydroxyapetite, which is a naturally occurring substance the body uses to form bone," he added.
"Most importantly," he said, "this procedure gives us a means of very rapidly relieving pain in individuals who have vertebral fractures. In my experience, virtually every patient has reported instant relief from the pain the moment the balloon restores the vertebrae. Overall, the case reports indicate kyphoplasty has a 96 percent chance of getting rid of the pain."
Like all surgical procedures and all medicines, however, the procedure is not without risk. Dr. Lane, who has been instrumental in developing the procedure, pointed out patients rarely experience side effects. One percent does experience treatable bleeding or respiratory distress, and one out of 200 patients has nerve injury-usually minor nerve irritation for a week after the procedure.
"Still, you have to put that in perspective," he said. "Vertebroplasty, the traditional procedure used, has a six percent complication rate and the crushed vertebrae is not repaired, it is only stabilized in place by injecting cement. Kyphoplasty restores the bone."
Dr. Lane said the procedure cannot correct healed fractures and must be done early. "We need to perform it within at least nine months of the occurrence," he explained. "Our results so far, show a 50 percent fracture reduction (bone restoration) if the procedure is performed within two months and a 35 percent reduction if performed within five months. In short, the sooner [we see an injured patient] the better our ability to correct the deformity." He added that the prime candidates for this procedure are patients who have experienced constant pain for two weeks or more following a fracture and patients who are beginning to develop vertebral deformities that will ultimately progress to a fracture. In the latter instance, kyphoplasty can actually be used to prevent curvature of the upper spine due to osteoporotic fracture (dowager's hump).
"Still, it needs to be noted we are in a very early developmental phase with this technique, and we're being very cautious," he pointed out. "At present, only ten surgeons are using the technique throughout the United States, and anyone who performs it must first complete a training course. That said, we are definitely seeing convincing evidence of a revolutionary technique capable of quickly getting rid of pain by repairing a spinal fracture, which was not previously possible."
Dr. Lane said patients interested in finding a doctor who does kyphoplasty should call the National Osteoporosis Foundation for referral to a doctor in their area who is qualified to perform it.