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Osteoporosis and cancer are diseases that can cause the spine's vertebral bodies
to weaken and become susceptible to fracture. Vertebral compression fractures
(VCFs) are painful, sometimes progressive and reduce the patient's quality of
life. Balloon Kyphoplasty, a minimally invasive procedure, offers patients with
a VCF hope for a pain-free and active life.
In the September 2006 issue of the journal Spine, Dr. Steven R. Garfin
and his colleagues published their research about Balloon Kyphoplasty. Although
their two-year study focused on the safety and effectiveness of Balloon Kyphoplasty
in elderly patients, their research findings are applicable to many patients
who suffer a VCF.
SpineUniverse is pleased to provide its readers with Dr. Garfin's comments
about VCFs and Balloon Kyphoplasty.
SpU: Is there a particular population subset that is more susceptible
to a vertebral compression fracture?
Dr. Garfin:
People who are more susceptible include those with osteoporosis, either primary
or secondary, multiple myeloma, or osteolytic metastatic tumors. I will briefly
explain each condition.
Primary osteoporosis is often related to aging, early menopause including
estrogen deficiency, inadequate calcium consumption, sedentary lifestyle, tobacco
use, and alcohol abuse.
Secondary osteoporosis develops from chronic systemic conditions that
can cause osteoporosis such as thyroid disease (for example, hyperparathyroidism),
long-term glucocorticoid therapy, kidney failure, or gastrointestinal diseases.
Multiple myeloma is a progressive cancer of the blood specifically affecting
the blood's plasma cells. The disease causes too many plasma cells to develop
in bone marrow. This upsets production of new bone and can lead to weakening
of the bones often involving the pelvis, ribs, skull, and spine.
Osteolytic metastatic tumors are cancerous tumors that spread from another
part of the body; usually from the lung or breast to the spine. Osteolytic means
the infrastructure of the bone (in this case, vertebrae) is severely weakened
(destroyed) creating a loss of the solid supporting structures of the bone,
allowing it to fracture/break.
Osteoporosis is the most common cause of a VCF. To determine if a vertebral
compression fracture is the cause of chronic back pain, doctors combine the
physical examination x-rays, MRI, CT scan, or bone scan.
SpU: Please tell us how a VCF affects the spine.
Dr. Garfin:
A vertebral compression fracture can be tragic in the sense of debilitating
pain and loss of physical function. Back pain is often agonizing and difficult
to manage nonoperatively. Pain directly affects the patient's ability to be
physically active. Simple activities of daily life, such as bending down to
pick up an object, lifting and standing can become difficult at best. Decreased
physical function can lead to fewer social interactions and emotional problems
such as depression.
Multiple vertebral compression fractures can cause spinal deformity. Sometimes
we see this in the form of a humpback. Spinal deformity can make breathing difficult
and is associated with the loss of lung function, is known to cause digestive
trouble, affects body balance, hinders walking, and increases mortality.
Some patients with a painful VCF spend much time in bed because of the pain
when upright. Studies prove that excessive bed rest leads to physical deconditioning
and more bone loss. Exactly what we want to avoid!
SpU: Is a VCF more serious than a hip fracture?
Dr. Garfin:
It is difficult to say which is more serious. Although a hip fracture can be
treated, complications, such as blood clots, can be life-threatening. Similar
to the development of osteoporosis, women are more likely to experience a hip
fracture than men because they lose bone density at a greater rate.
Clinical research has demonstrated that the mortality rate of elderly patients
who suffer a VCF exceeds that of patients who have suffered a hip fracture.
Additional problems increase with each new VCF.
SpU: What are the benefits of Balloon Kyphoplasty?
Dr. Garfin:
Our study originally enrolled 155 elderly patients with painful VCFs; 100 patients
were followed over a two-year time period. Preoperative pain was measured using
a pain scale from 1 to 20; one represented no pain and 20 as agonizing. Patients
who participated in the study reported preoperative pain averaging 15/20; meaning
they rated their pain as dreadful to horrible. In stark contrast, patients who
underwent Balloon Kyphoplasty experienced immediate, dramatic and continued
pain relief. This type of pain relief is difficult to attain nonoperatively.
Balloon Kyphoplasty also restores a measure of the vertebral body height lost
when the vertebral body becomes compressed. Our patients reported a high-level
of satisfaction with the procedure and were able to resume most activities of
daily living quickly.
SpU: Where there complications during the Balloon Kyphoplasty procedures?
Dr. Garfin:
With any surgical procedure there are risks and the chance for complications.
However, complications during our study were minimal. In fact, no complications
were caused by the Balloon Kyphoplasty procedure or devices.
SpU: Thank you Dr. Garfin.
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