Balloon tool surgery a breakthrough in spine health
Monday, June 04 2007, 01:28 AM EDT
Contributed by: Ryan Ori
TOWARD BETTER BACKS
Kyphoplasty. Big word, big potential.
And for patient Mary Jane Brandt, big doubts.
"I was very skeptical," she said. "It sounded too good to be true."
The 79-year-old Washington, Ill., woman fell at home in January. She broke two ribs and suffered a compression fracture in one vertebra. It hurt to sit up, which reduced her appetite.
"I couldn't sit up because my spine was crushed and the little splinters were hitting up against the nerves, I guess, when I sat down," Brandt said. "It was very painful."
A little more than two weeks later, she underwent a balloon kyphoplasty procedure performed by Dr. Bob Smouse at Proctor Hospital in Peoria, Ill.
Brandt was surprised results were so instant.
"I sat up the next morning and had breakfast, which I hadn't done for almost three weeks," Brandt said. "It felt good. Now I can do anything I could do before."
Forms of vertebral augmentation - vertebroplasty and kyphoplasty - are used to heal breaks to the vertebrae, which are bones in the spine.
VERTEBRAL COMPRESSION FRACTURES
Kyphoplasty was developed in the 1990s.
In stabilizing the fracture, kyphoplasty can reduce back pain, restore height and improve spinal alignment.
People with osteoporosis, most frequently elderly women, are most susceptible to fractures in the spine. Some forms of cancer also weaken bones and create a vertebral fracture.
Patients who go untreated can remain in pain for years. Their posture often becomes stooped, which leads to a variety of health complications.
"It's a huge development," Smouse said of kyphoplasty. "This affects millions upon millions of patients in the United States each year."
Through reading medical research and observation of his own patients, Smouse estimates the treatment is effective in far more than 90 percent of those who suffer vertebral compression fractures. Kyphoplasty is available in many cities, but there are relatively few doctors performing it.
Smouse estimates there are about 30 doctors offering balloon kyphoplasty in Illinois, including a handful in Peoria.
Smouse performs the procedure at Proctor, while Central Illinois Radiological Associates partners Larry Wang and Michael Zagardo offer it at OSF Saint Francis Medical Center.
According to Smouse, an interventional radiologist at Proctor and St. Francis, radiologists are a natural fit for kyphoplasty because of their familiarity with fluoroscopy, which serves as a real-time X-ray.
Kyphoplasty takes about an hour.
Local and general anesthesia can be given to a patient, who is placed face down in the fluoroscopy machine.
One side of the machine gives off radiation, while the other side provides a real-time image of the patient's spine.
Two needles are inserted into the spine, one on each side of the fractured vertebra.
Unlike vertebroplasty, kyphoplasty utilizes balloons.
Balloons are inserted and inflated using saline. That compresses bone fractures, stabilizes the fracture and re-establishes some of the space needed between vertebrae. The result is a more upright posture.
After the balloons are withdrawn back through a chamber of the needle, bone cement is added to the syringe. The cement quickly hardens, healing the bone and maintaining the re-established height in the spine.
"It's kind of like putting a cast on the inside of a broken bone," Smouse said. "It re-establishes stability and height. That cement is actually harder than any bone in our bodies."
Patients usually are kept overnight at the hospital, then sent home the next day.
"It's amazing the pain relief they get," Smouse said. "They can be going months on narcotics, very restricted movement, can't walk, can't get out of bed. You do this and the next day they're walking out of the hospital."
Kyphoplasty can't be used in all spinal fractures, and it doesn't restore all of an elderly patient's lost height. The procedure can only be performed up to six months after the fracture occurs. Otherwise, the vertebra scars and flattens too much.
"We like to intervene early," Smouse said. "Earlier is better, we think. When they get an acute fracture, the best time to treat it is right away - before there's further loss of the height of the vertebral body."
MORE SURGERY
Mary Kennedy of Peoria was hospitalized to repair a compound fracture in her ankle suffered during a fall in February. While there, MRIs showed a crumbling vertebra.
Smouse performed that procedure on the 79-year-old with two back surgeries in her past.
"I have a plate and screws in my back, but this (vertebra) is higher up," Kennedy said. "They said, 'As long as you're here, we can really do something.' It wasn't bothering me that much, but now I don't have as much backache. I'll always have backache because of all the other stuff, and I'll probably need (kyphoplasty) again because another vertebra looks like it's crumbling.
"There really wasn't much to it. I really didn't feel anything, and all you can see is two little pinholes, one on each side of the vertebra."
Despite the need for some patients to repeat the procedure over time, Smouse is encouraged by the high success rate and low risk of complications. Also, patients often are able to discontinue use of pain medication.
"We can keep the complication rate very low, under 1 percent," Smouse said. "Patients have significant pain reduction or complete absence of pain in about 95 to 97 percent of cases."
Brandt has resumed favorite activities, such as China painting, and looks forward to another spring and summer working in her garden.
"I'd never heard of it before they asked me if I wanted to have it done," Brandt said. "This is absolutely wonderful. It's like a miracle to me."
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