Today’s physicians have many choices for the treatment of back pain. Their options range from conservative treatments like physical therapy and TENS units to more interventional procedures such as steroid injections, radiofrequency nerve–burning, and electrical stimulation of the spinal cord. When back pain is caused by vertebral compression fractures, one of the best options for treatment is Kyphoplasty. This simple outpatient procedure can restore vertebral alignment, improve pulmonary function, and dramatically reduce back pain, if not cure it altogether. According to the Kyphon website, approximately 350,000 patients have already undergone the Kyphoplasty procedure worldwide.
The three most common causes of vertebral compression fractures, or fractures of the bones of the spine, are osteoporosis, cancer, and trauma, with osteoporosis being the most common as reported by the American Pain Foundation.
There is an annual occurrence of 700,000 vertebral compression fractures in the United States alone and as our population ages the numbers will increase every year. Furthermore, once somebody has experienced their first vertebral compression fracture, they are five times more likely to have another fracture and after two fractures, they are 12 times more likely to experience additional fractures. Although the vertebral compression fracture can be extremely painful, the diagnosis can be made with a simple X–ray.
Once a vertebral compression fracture is diagnosed, there are basically two options for treatment: (1) narcotic management of the pain or (2) fracture stabilization. Since narcotic management of the pain will not solve the pain problem the recommended option is stabilization. There are only two procedures for stabilizing the fracture: Vertebroplasty and Kyphoplasty.
Vertebroplasty involves insertion of one needle into the fractured bone and injection of cement. Kyphoplasty differs from Vertebroplasty in that it involves inflating a balloon within the fractured bone to create a cavity to be filled therefore reducing the compression fracture back toward its normal anatomy. To illustrate, picture the crushing of an aluminum soda can, then putting a balloon inside the can and blowing up the balloon to re–expand the can to its original shape. Once the cavity is made and the fracture reduced, the balloon is removed and cement is injected into the cavity. The cement then stabilizes the fracture and greatly reduces the small movements of bone responsible for the pain. The entire minimally invasive out–patient procedure is done through two tubes about the size of straws and takes about 30 minutes. The patient is then discharged once they are stable.
There is an abundance of literature supporting the efficacy of Kyphoplasty. Current studies are ongoing with a head–to–head comparison of Kyphoplasty versus Vertebroplasty. The cited benefits of Kyphoplasty include greatly decreased need for pain medicines including narcotics. As the micro–motion of the fractured bone is minimized, the pain–generating signals are eliminated. Furthermore, the ability to ambulate is greatly increased due to the pain reduction. Restoration of the fractured vertebral body to more of its normal anatomic alignment is also observed, which provides maintenance for years.
Even sleep is improved as the pressure on the vertebral body is no longer painful.
Interestingly, it is not uncommon for these fractures to be found by accident when evaluating other medical problems. Patients will commonly report they have no idea what could have caused these fractures or when they occurred. Fortunately, these patients can obtain benefits as well. By two weeks after the procedure, 90% of patients with new onset fractures and 87% of patients with old fractures report pain relief. Therefore, for patients that have had back pain for a long period of time and never had x–rays or other imaging modalities performed, a simple X–ray could start them on the road to recovery and alleviation of their pain.
Finally, with the American population growing older and the number of Americans over 60 continuously increasing, it is not surprising that physicians will treat more and more patients with back pain. The statistics are staggering. Most recent cited facts report up to 80% of patients will suffer from back pain at some time in their life. Of these, 90% will have this pain resolve within two months. However, of the 10% of patients with pain that does not resolve, 85% of these patients will not obtain a specific diagnosis for their pain.
As stated, there are rare situations in medicine when a physician can evaluate a patient who has long–term pain and think this patient’s pain can be significantly reduced. Whether the back pain stems from a trauma, cancer, osteoporosis, or any other cause of vertebral compression fracture, Kyphoplasty is a great option. Physicians and patients alike should consider Kyphoplasty to treat, and possibly resolve, patients’ pain.
