By Mark W. McFarland, DO and Raj N. Sureja, MD
Vertebral compression fractures are observed in any age demographic due to trauma from a fall or a car accident; however, they are most prevalent in the geriatric population. Significant loss of bone may occur due to pathology (cancer, osteomyelitis); chemotherapy or radiation therapy used to treat cancer; age-related conditions (hyperthyroidism, menopause, osteoporosis) or can be caused by an overuse of steroids. When enough bone loss occurs, and a vertebra becomes unstable, spinal fracture or collapse is likely to occur. These vertebral fractures can be extremely debilitating for the seniors who suffer them, causing pain, uncomfortable neurologic symptoms, disability and urinary or fecal incontinence/retention.
Until recently, these individuals would have been sent to the hospital for treatment with Vertebroplasty or Kyphoplasty procedures. Both procedures provide a method for stabilizing the vertebral fracture, using a bone cement to restore height and strength to the collapsed or fractured bone. Kyphoplasty differs from a Vertebroplasty, mainly because a balloon is inserted into the fractured vertebra, inflated to restore the height and then cement injected into the space, which hardens to provide stability. In an outpatient setting at a hospital or ASC, the patient would be usually subjected to general anesthesia and a stay which typically would take four to six hours. The hospital cost for the procedure is substantial, resulting in a greater out-of-pocket expenditure for the patient.
In 2012, Medicare approved in-office Kyphoplasty for reimbursement, due to significant improvements and miniaturization of the required instrumentation, such as smaller needles and special blocks for anesthetizing the operative site. After this approval, many Orthopaedic Spine physicians and Radiological Interventionists began performing this procedure in their clinical office procedure suites. The patient is awake during the procedure, which takes about 30 minutes, and is ready to go home in approximately 90 minutes. Another improvement occurred in 2014, with the development of a small trochanter which provided a less-invasive way for the surgeon to enter the body near the fractured vertebrae, causing less trauma for the patient.
Although a few earlier studies brought the efficacy of Kyphoplasty into question, more recent clinical research has found that Kyphoplasty is preferable over Vertebroplasty and non-surgical management for vertebral compression fractures. Kyphoplasty provides distinct benefits when measured against in pain reduction, disability management and quality of life indicators. Anecdotally, we observe these patients in our office on a regular basis. They frequently arrive in a wheelchair, unable to walk and in a great deal of pain. After their in-office balloon Kyphoplasty, patients can walk, their disability gone. The pain relief they experience is immediate, and their gratitude is one the best rewards for any physician performing the procedure.
We perform several Kyphoplasties a week in our office at OSC. Our patients tolerate the procedure very well and experience immediate relief from their symptoms. If your geriatric patients experience vertebral compression fractures, consider the benefits of in-office Kyphoplasty.
Mark W. McFarland, DO (Orthopaedic Spine), and Raj N. Sureja, MD (Interventional Pain Management) practice at Orthopaedic & Spine Center in Newport News, VA. For more information on Kyphoplasty, please contact them at 757-596-1900 or visit osc-ortho.com.
