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Kyphoplasty for the Treatment of Vertebral Compression Fractures

Kyphoplasty for the Treatment of Vertebral Compression Fractures. Jessica Brock Advised by Sam Powdrill. Vertebral Compression Fractures. The most common complication of osteoporosis Estimated 700,000 VCFs occur annually 200,000 are refractory to medical management

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Kyphoplasty for the Treatment of Vertebral Compression Fractures

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  1. Kyphoplasty for the Treatment of Vertebral Compression Fractures Jessica Brock Advised by Sam Powdrill

  2. Vertebral Compression Fractures • The most common complication of osteoporosis • Estimated 700,000 VCFs occur annually 200,000 are refractory to medical management • Cost $10-15 billion annually • Can result in spinal deformity: kyphosis/lordosis • Cause acute and chronic pain leading to disability • Cause of reduced vital capacity

  3. Osteoporosis VCFs Spinal Deformity Decreased lung capacity Decreased physical function Early Satiety Sleep problems Decreased activity More bone loss Increased fracture risk Decreased pulmonary function Increased mortality The Downward Spiral

  4. Prevention • Bone Density Testing in women > 65 year, men > 70 years • Adequate intake of calcium, vitamin D, and regular weight bearing exercise • Pharmacology: bisphosphonates, calcitonin, SERMS • Reduce the risk of falling

  5. Signs and Symptoms • Consider VCF in any patient > 50 years if they complain of acute or chronic back pain • Get a AP and lateral x-ray of the spine • Look for wedge shaped vertebral bodies • MRI with T2 sequence shows state of fracture healing

  6. Conservative Therapy • NSAIDS • Opiods • Muscle relaxants • Bed rest • Orthotic bracing • VCF healing should occur in 6-12 weeks • Refractory in 15-20% of patients

  7. Kyphoplasty • Minimally-invasive • Percutaneous • Can restore lost vertebral height • Immediate pain reduction • Fewer complications compared to vertebroplasty • By 2005, performed on 170,000 patients

  8. Kyphoplasty • 2 fluoroscopy units for visualization • Patient is supported in prone position • 4 cm bilateral incision via the pedicles using trocar, guidewire, cannula, bone tamp, cement • Maximum of 3 vertebral bodies

  9. Complications • Cement Extravasation • Pulmonary embolism • Abscesses • Disc damage • Adjacent VCFs post surgery—20-30% • General complication rate 1-2%

  10. Conclusions • Kyphoplasty is a safe and effective treatment for back pain due to osteoporotic VCFs. • Providers should include kyphoplasty in the discussion of options for the VCF patient • Reimbursement available by Medicare and private insurance companies

  11. References • ACP medicine, Dale, D, and Federman, D. 3rd edition. WebMD Professional Publishing. • New York, NY. 2007, Vol. I, 707-711 • Albertico, RA. Balloon Kyphoplasty for Multilevel Spinal Metastases from Breast • Cancer. J Support Oncol 2007;5:243-246 • Garfin, SR, Buckley, RA, and Ledlie, J. Balloon kyphoplasty for symptomatic vertebral • body compression fractures results in rapid, significant, and sustained • improvements in back pain, function, and quality of life for elderly patients. • Spine, 2006. 31(9), p.2213-20. • Hanna, J, and Letizia, M. A treatment for osteoporotic vertebral compression fractures. • Orthopedic Nursing. Vol 26(6). 2007. pg 342-346. • Harrison, AL. Changes in the Bone Associated with Aging. Lecture at the University of • Kentucky. Summer 2007. • Howland, RD, and Mycek MJ. Pharmacology. 3rd edition. Lippincott Williams & • Wilkins. Philadelphia. 2006. • Ledlie, JT and Renfro, MB. Kyphoplasty treatment of vertebral fractures: 2-year • outcomes show sustained benefits. Spine, 2006. 31(1): p.57-64 • Pateder, DB, Khanna AJ, and Lieberman, IH. Vertebroplasty and Kyphoplasty for the • Management of Osteoporotic Vertebral Compression Fractures. Orthop Clin N • Am 38 (2007) 409-418. • Robinson, Y., Tschoke, SK., Stahel, PF, Kayser, R., and Heyde, CE. Complications and • safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective • follow-up study in 102 consecutive patients. Patient Safety in Surgery 2008, 2:2. • Surgeon General’s Report on Bone Health and Osteoporosis. 2004. • Taylor, RS, Fritzell, P, and Taylor, RJ. Ballon kyphoplasty in the management of • vertebral compression fractures: an updated systematic review and meta-analysis. • Eur Spine J (2007) 16:1085-1100. • Vajnar, J. Compression Fractures in a Man with Osteoporosis. JAAPA Sept 2007, 20(9). • Resources: • National Osteoporosis Foundation www.nof.org • Kyphon, Inc. Sunnydale, CA

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