One of the most exciting new approaches to easing the painful spinal compression fractures that can go with advanced cases of osteoporosis has been injecting a bone cement into the vertebrae. Known as percutaneous vertebroplasty, the technique has proved amazingly effective in stabilizing the spine and preventing further breakdown in the bone. But while vertebroplasty solidifies the bone in the position that it’s in, it doesn’t correct additional problems caused by the compression fracture. That is, as the thick block of bone at the front of each vertebra collapses, the spine shortens and falls forward. The curved spine then presses on the lungs, reducing their air capacity and increasing the patients’ risk of pulmonary disease. Now, orthopedic surgeon David Cohen, M.D., is using one more new procedure in this march against osteoporosis, called " balloon kyphoplasty," to relieve both the spinal deformity and the pulmonary problems that go with compression fractures. Here’s how the procedure works. Before injecting the bone cement, Cohen inflates a balloon under X-ray guidance into the space left by the fracture and expands it. He then pushes the collapsed bone back into place, restoring the height of the fractured vertebra. The balloon is deflated and removed, leaving a cavity that the surgeon fills with bone cement, creating an internal cast and preventing further collapse. In a study of 80 patients by Kyphon, the manufacturer of the balloon device, 90 percent reported significant pain relief. In 16 cases, 70 percent of lost vertebral body height was restored, and in six cases stooping was reduced by 50 percent. There was a low complication rate of 3 percent and no failures 12 months after surgery. "It’s an excellent procedure in terms of relieving pain," says Cohen, but also in dealing with what could become life-threatening pulmonary problems. Osteoporosis patients with vertebral fractures, he points out, have a 200 percent higher risk of pulmonary death than osteoporosis patients who don’t have these fractures. -- Gary Logan
Hopkins Medical News, Spring 2000 | 
