Kyphoplasty for the Kyphoplasty for the Treatment of Vertebral Treatment of Vertebral Compression FracturesCompression Fractures

Jessica BrockJessica Brock

Advised by Sam PowdrillAdvised by Sam Powdrill

Vertebral Compression Vertebral Compression FracturesFractures

The most common complication of The most common complication of osteoporosisosteoporosis

Estimated 700,000 VCFs occur annuallyEstimated 700,000 VCFs occur annually200,000 are refractory to medical management200,000 are refractory to medical management Cost $10-15 billion annuallyCost $10-15 billion annually

Can result in spinal deformity: Can result in spinal deformity: kyphosis/lordosiskyphosis/lordosis

Cause acute and chronic pain leading to Cause acute and chronic pain leading to disabilitydisability

Cause of reduced vital capacityCause of reduced vital capacity

The Downward SpiralThe Downward Spiral

OsteoporosisOsteoporosis VCFsVCFs Spinal DeformitySpinal Deformity Decreased lung Decreased lung

capacitycapacity Decreased physical Decreased physical

functionfunction Early SatietyEarly Satiety

Sleep problemsSleep problems Decreased activityDecreased activity More bone lossMore bone loss Increased fracture Increased fracture

riskrisk Decreased Decreased

pulmonary functionpulmonary function Increased mortalityIncreased mortality

PreventionPrevention

Bone Density Testing in women > 65 Bone Density Testing in women > 65 year, men > 70 yearsyear, men > 70 years

Adequate intake of calcium, vitamin Adequate intake of calcium, vitamin D, and regular weight bearing D, and regular weight bearing exerciseexercise

Pharmacology: bisphosphonates, Pharmacology: bisphosphonates, calcitonin, SERMScalcitonin, SERMS

Reduce the risk of fallingReduce the risk of falling

Signs and SymptomsSigns and Symptoms

Consider VCF in any patient > 50 Consider VCF in any patient > 50 years if they complain of acute or years if they complain of acute or chronic back painchronic back pain

Get a AP and lateral x-ray of the spineGet a AP and lateral x-ray of the spine Look for wedge shaped vertebral Look for wedge shaped vertebral

bodiesbodies MRI with T2 sequence shows state of MRI with T2 sequence shows state of

fracture healingfracture healing

Conservative TherapyConservative Therapy

NSAIDSNSAIDS OpiodsOpiods Muscle relaxantsMuscle relaxants Bed restBed rest Orthotic bracingOrthotic bracing VCF healing should occur in 6-12 VCF healing should occur in 6-12

weeksweeks Refractory in 15-20% of patientsRefractory in 15-20% of patients

KyphoplastyKyphoplasty

Minimally-invasiveMinimally-invasive PercutaneousPercutaneous Can restore lost vertebral heightCan restore lost vertebral height Immediate pain reductionImmediate pain reduction Fewer complications compared to Fewer complications compared to

vertebroplastyvertebroplasty By 2005, performed on 170,000 By 2005, performed on 170,000

patientspatients

KyphoplastyKyphoplasty

2 fluoroscopy units for visualization2 fluoroscopy units for visualization Patient is supported in prone positionPatient is supported in prone position 4 cm bilateral incision via the 4 cm bilateral incision via the

pedicles using trocar, guidewire, pedicles using trocar, guidewire, cannula, bone tamp, cementcannula, bone tamp, cement

Maximum of 3 vertebral bodiesMaximum of 3 vertebral bodies

ComplicationsComplications

Cement ExtravasationCement Extravasation– Pulmonary embolismPulmonary embolism– AbscessesAbscesses– Disc damageDisc damage

Adjacent VCFs post surgery—20-30%Adjacent VCFs post surgery—20-30% General complication rate 1-2%General complication rate 1-2%

ConclusionsConclusions

Kyphoplasty is a safe and effective Kyphoplasty is a safe and effective treatment for back pain due to treatment for back pain due to osteoporotic VCFs.osteoporotic VCFs.

Providers should include kyphoplasty Providers should include kyphoplasty in the discussion of options for the in the discussion of options for the VCF patientVCF patient

Reimbursement available by Medicare Reimbursement available by Medicare and private insurance companiesand private insurance companies

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