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kyphoplasty


  • What is osteoporosis?
  • What is kyphosis?
  • Balloons for Bones - The Kyphoplasty Procedure
  • The Downward Spiral
  • Treating Vertebral Compression Fractures

    What is osteoporosis?
    Osteoporosis is a disease that causes the bone to become thin and weak. If occurs mostly in post-menopausal women because the female hormone estrogen helps maintain bone strength. As estrogen levels decline, bone is lost. Osteoporosis can also occur in men, as a result of late puberty, poor calcium intake, smoking, excessive alcohol consumption or from certain medications such as glucocorticoids.

    As bones weaken, they are more likely to break (fracture). The hip, wrist and spine bones are at the greatest risk of fracture. These breaks in the spine are known as vertebral compression fractures, or VCF's. Left untreated, they may lead to kyphosis, commonly referred to as "dowager's hump".

    Risk Factors
    You are at increased risk for osteoporosis if:
    • Your body no longer produces estrogen
    • There is not enough calcium in your diet
    • You smoke, drink alcohol or take certain medications
    • You do not exercise regularly
    Statistics
    According to the National Osteoporosis Foundation (www.nog.org), half of all post-menopausal women are at risk for developing osteoporosis. They repost that the condition occurs 5 times more often in women than in men, yet most women ages 45-75 have never even discussed the issue with her doctor. 77% of women who already have the condition are not getting diagnosed and 90% receive no treatment.

    Consequences of osteoporosis that patients may suffer include:
    • The association between low bone mass and fracture is stronger than that between systolic blood pressure and stroke.
    • The association between low bone mass and fracture is stronger than that between serum cholesterol and coronary events.
    • Patients with vertebral fractures have nearly double the risk of a hip fracture.
    • At age 50, a woman has a 40% chance of suffering an osteoporotic fracture in her remaining lifetime. That is equal to her risk of breast, uterine and ovarian cancer combined!
    • Two or more prior vertebral fractures are associated with a 12-fold increase in the risk of future vertebral fracture(s).
    Your bones change over time.

    Bone mass gives your bones density and strength. Throughout your life, your body loses bone mass, but new bone grows to replace lost bone. The rate of new bone growth changes as you age. When you are young, the amount of new bone your produce is normally more than the amount of bone lost. Thus children's bones grow quickly, reaching their full length in the teenage years. Between the ages of 25 and 35, your bones thicken, reaching their "peak bone mass".

    The picture on the right is a microscopic view of normal bone and osteoporotic bone. Note how much denser the normal bone is. This is an example of peak bone mass, when the bones are strongest. Estrogen helps women to maintain peak bone mass, along with exercise and a lot of calcium. As you approach menopause, however, estrogen production declines, and your body is less able to stay ahead of the bone loss. After menopause, the rate of bone loss slows, but your body may still be losing bone faster than it can replace it. Your bones can become weak, brittle and subject to fractures from falls or back strains. This is osteoporosis.

    What is kyphosis?

    The term "kyphosis" (ki-fo-sis) refers to an exaggerated curvature of the spine that results in a rounded or hunched back. When seen from the side, a normal spinal column has a number of gentle curves due to the shape and alignment of the vertebrae. In a healthy spine, a 25-40 degree thoracic curve is considered normal. When the thoracic curve is greater than 40 degrees medical attention is recommended.

    Kyphosis develops for several different reasons. For example, slouching and poor posture can increase the natural curve of the spine. This most commonly happens in adolescent girls. It rarely causes pain, and can be corrected with exercises and improved posture.

    Another type of kyphosis may develop in later life, especially for women, as a result of osteoporosis. As the bones of the spine weaken and become more porous, they experience small fractures that cause them to compress upon each other (vertebral compression fractures). The result is sometimes called a "dowager's hump" and, left unattended, becomes gradually more pronounced, more painful and more debilitating.

    Balloons for Bone - The Kyphoplasty Procedure

    The KyphX® Inflatable Bone Tamp (Balloon) is a new tool doctors are using in the treatment of spine fractures.

    Every 45 seconds osteoporosis causes a spine fracture (VCF)1. Most VCF's occur when the bones in the spine weaken and collapse.

    Minimally Invasive Fracture Reduction:

    Through a small incision, the doctor creates a narrow pathway in the fractured bone and inserts a KyphX Balloon.

    The KyphX Balloon is inflated, moving the collapsed portion of the vertebra. The purpose for this is to restore the fractured bone to its original shape.

    Once the doctor has achieved the desired result, the KyphX Balloon is deflated and removed. The doctor can then finish the procedure.

    The Downward Spiral

    A single Vertebral Compression Fracture (VCF) can start the downward spiral. The first VCF changes the alignment of the spine and increases the risks of future VCF's. As more VCF's occur, the spine shortens and falls forward, resulting in thoracic and lumbar spine deformity. Spinal deformity compresses the chest and abdominal cavity with the following potential consequences:
    • Chronic, debilitation pain.2
    • Spinal deformity can shift the center of gravity, reducing balance and increasing the risk of falls.
    • Decreased lung function.3
    • Sleeping Disorders.4
    • Decreased activities of daily life and increased dependence on family and friends.5,6
    • Clinical Anxiety and/or depression.4,6
    Every fracture may contribute to this unpleasant downward spiral.

    Treating Vertebral Compression Fractures

    Traditional treatment options have been limited. Conventional actions, consisting of bed rest, pain medication and back braces, are the current standard of care. This type of medical management may not always help to manage pain caused by VCF's, and it does not correct spinal deformity. Generally, conservative surgical methods to correct the spinal deformity are too invasive, and outcomes are poor in osteoporotic bone.

    Ideally, fracture treatment should meet certain objectives:
    • Restore structure relationships through fracture reduction and fixation.7
    • Produce optimal outcomes with early diagnosis and treatment.8
    • Take special care to accommodate the frail physical status and co-morbidities of geriatric patients.8
    Early referral to specialist Joseph J. Williams of the Bone and Joint Institute can determine the appropriate treatment and inevitably restore your quality of life.

    1 Riggs, Melton, Bone 1995; Vol. 17, No. 5
    2 Lyles, et al., Association of Osteoporotic Vertebral Compression Fractures with Impaired Functional Status, Am J. Med, 1993, 94:595-601
    3 Leech, Relationship of Lung Function to Severity of Osteoporosis in Women, Am Rev Respir Dis 1990, 141:68-71
    4 Silverman, The Clinical Consequences of Vertebral Compression Fracture, Bone, 1992, 13:S27-31
    5 Lyles, et al., The Association of Radiographically Detected Vertebral Fractures with Back Pain and Function: A Prospective Study, Annals Int Med, 1998; 128:10:793-800
    6 Gold, The Clinical Impact of Vertebral Body Fractures: Quality of Life in Women with Osteoporosis, Bone, 1996, 18:S185-189
    7 Schatzker, AO Philosophy and Principles, AO Principles of Fracture Management, Thieme, 2000, 1.1.6
    8 Brakoniecki, Anesthetic Management of the Trauma Patient with Skeletal Injuries, Skeletal Trauma, W.B. Saunders Company, 1998, 1:7:171-172