Balloon kyphoplasty provides immediate results for vertebrae compression fractures

Patients who had balloon kyphoplasty saw significant drops in pain and increased function.

Older osteoporosis patients may see a significant reduction in pain and improvement in function after undergoing balloon kyphoplasty, according to a recent study.

Lead author Steven R. Garfin, MD, of the University of California, San Diego, along with colleagues from the Balloon Kyphoplasty Outcomes Group, analyzed the effects of this procedure in 155 older adults with vertebral compression fractures (VCFs) caused by osteoporosis. A major goal of this study: to determine the long-term effects of the procedure and quality of life measurements of kyphoplasty patients.

The 155 patients underwent the surgery at 19 various hospitals throughout the United States. In 43 patients two or more fractures were treated.

The minimally-invasive procedure is performed under fluoroscopy and typically takes less than one hour for each spinal fracture to be treated, and can be performed under local or general anesthesia, Garfin told Orthopedics Today. Small orthopedic balloons are used to gently elevate the collapsed bone so that the fractured vertebra can regain its normal and correct shape. The balloons are then deflated and removed. This leaves a cavity in the vertebrae, which is filled with PMMA bone cement, forming an internal cast to stabilize the bone and prevent future collapse, Garfin explained.

"When I first learned of the development of the balloon kyphoplasty procedures, it made perfect sense," Garfin said. "Whereas hip and wrist fractures are generally treated acutely with orthopedic intervention, traditionally accepted methods for treating VCFs seemed to me, as an orthopedic spine surgeon, to be unsatisfactory."

Garfin said that this procedure also fulfills the four principles of fracture management: anatomy restoration, rigid fixation, minimal tissue disruption and safe and early mobilization.

The study, which was published in the journal Spine, had results that showed few complications, and patients reported feeling almost immediate pain relief. Prior to the kyphoplasty, patients averaged a pain score of 15 on a 20-point scale. After surgery, the patients' average had dropped to 6, remaining stable through the two-year follow-up. At 24-month follow-up, 87% of patients reported no days in bed due to back pain, whereas 46% of patients needed bed rest prior to the kyphoplasty.

Garfin said that the study results are evidence that the procedure can provide long-lasting relief and improvement for patients.

The number of study patients who had improvement in back function and were able to perform common activities such as lifting and bending without difficulty increased from 20% of patients preop to 50% postop.

All SF-36 quality of life measures except for general health improved immediately, Garfin said.

Also, patients were satisfied by the procedure, giving it a mean rating of 18 out of 20 at seven days postop.

"We've shown it does it two years, so I think it'll last indefinitely at least," Garfin said. "I've been doing this since 1996 and I haven't had anybody come back with increased pain unless they've had another fracture."

Balloon kyphoplasty has been used to treat more than 275,000 vertebral compression fractures worldwide since 1998, Garfin said.

"The important message is it's safe, it's dramatic relief, provides an improvement in function and it lasts. Patients don't have to suffer indefinitely, if they have a fracture and they don't get better in a reasonable period of time or they're markedly debilitated or they're hospitalized with pain, I think that we ought to consider doing the kyphoplasty, and getting it done quickly so they can get back to life. It works, it helps, and there's minimal risk," Garfin said.

For more information:
Garfin SR, Buckley RA, 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):2213-2220.