Pain relief procedure for spinal compression fractures can correct widow's hump deformity as well

Thursday, August 29, 2002

JACKSONVILLE, Fla., Aug. 29, 2002 — Osteoporosis, loss of bone mass characterized by weak, brittle bones, affects about 28 million Americans. Each year about 700,000 of them suffer painful, debilitating compression fractures of the spine. These fractures compress the front of the spinal bones (vertebrae) and result in a pronounced forward spinal curve (kyphosis), often called widow's hump. This deformity can lead to other serious health problems. Doctors at Mayo Clinic in Jacksonville, Fla., are performing kyphoplasty, a minimally invasive procedure that offers almost immediate pain relief and the potential to restore bone height and reverse kyphosis.

Kyphoplasty is usually performed with a local anesthetic to numb the back. The patient lies face down, and the physician makes a small incision in the back. Then, assisted by real-time X-ray images — a process called fluoroscopy — the physician guides a thin tube into the fractured vertebrae. Through the tube, the physician drills a small hole through the hard, outer part of the bone and into its softer center. This provides a pathway for the physician to insert a small, special balloon into the interior of the vertebrae. Once the balloon is correctly placed, it's inflated. This pushes bone out of the way and pushes apart the caps, or endplates, of the fractured vertebrae. The goal is to restore the vertebrae to its original shape as much as possible. The balloon is then deflated and removed, leaving a cavity that the physician fills with a quick-drying bone cement.

The procedure takes about 30 to 40 minutes. Patients stay in bed and are observed for about two hours after the procedure. Then they get up and move around. After an overnight hospital stay, they may resume normal activities.

Dr. David Miller is a Mayo Clinic interventional neuroradiologist who performs kyphoplasty. He calls it good news for patients with osteoporosis. "It's exciting, especially for patients who have developed a significant kyphotic deformity," he says, "because kyphoplasty offers at least the chance of reversing some of the deformity that's associated with these fractures."

Miller says the procedure is most successful in restoring bone height and correcting deformity if it's done on relatively recent compression fractures ¯ those caught within two to three months. That's one reason why he encourages patients to seek treatment early.

He says people usually know when they've suffered a compression fracture because of the severe, acute pain. "This pain often lessens over the first couple of weeks," Miller says. "Then it either disappears as the fracture heals, or if the fracture doesn't totally heal, the pain generally settles in as a chronic sort of dull backache that's worse when patients are standing, going from sitting to standing and at the end of the day."

In terms of achieving pain relief, Miller says kyphoplasty is as effective as a similar procedure, called vertebroplasty, which he's been performing since 1999. Vertebroplasty does not offer the potential to restore bone height or reverse deformity, but it can be used to relieve pain from compression fractures over more of the spine. Kyphoplasty is limited to treating the lumbar (lower) and bottom half of the thoracic (middle) spine.

Currently physicians are filling the created bone cavity with the special cement, but Miller sees future implications for kyphoplasty. "I think the technique certainly lends itself to possible future treatments," he says. "These may include injecting genetically engineered bone materials and other things, which would cause bony regrowth, rather than just bone cement."

Miller says one day kyphoplasty and vertebroplasty may be as antiquated as they are now novel. "My hope is that these techniques will be helpful until we have better agents for fighting osteoporosis, and then they won't be necessary," he says. "I'm hoping to put myself out of business with better bone-building agents, but until then, this offers a hope for those people who have fractures and pain and also people with significant spinal deformity associated with compression fractures."

###

To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. MayoClinic.com is available as a resource for your health stories.