New procedure repairs vertebrae, restores height of patients with osteoporosis
Osteoporosis is often called a silent disease because the bone loss it causes happens without symptoms. But this loss of bone density, which is widespread among older adults, can lead to fractures, often in the vertebra of the spine.
Vertebral fractures can cause debilitating back pain and stooped posture, known as kyphosis, or "dowager's hump."
A new, minimally invasive surgical procedure treats spine fractures and actually can reverse the loss of height associated with kyphosis. Rida Mazagri, M.D., a neurosurgeon with Tri-State Neuroscience Center, has been performing this surgery, known as kyphoplasty, in Huntington since he came here to practice in June.
"This procedure to treat osteoporotic compression fractures, which usually appear in the elderly, removes pain and restores the deformity," Dr. Mazagri said. "It actually provides correction of the 'hump.'"
Kyphoplasty utilizes a specialized tool, the KyphX Xpander inflatable bone tamp, which is essentially a balloon that prepares a space for special cement.
"In kyphoplasty, I use a needle under X-ray guidance to go the fracture site, where I inflate a balloon, which elevates the fracture to restore height," Dr. Mazagri said. "I inject cement into the cavity created by the balloon. This puts the fracture in place and prevents any motion, while restoring the height of that vertebra."
The procedure is done through small skin incisions on each side of the fractured vertebra. It may be performed on more than one vertebra if the patient has multiple fractures.
Kyphoplasty offers advancements on previously available surgical techniques, which included open surgery and vertebroplasty, Dr. Mazagri said.
"It used to be that a patient would have to have open surgery," Dr. Mazagri said. "But many of these patients are elderly and a certain number are too frail."
In contrast to the hospitalization and recovery period for open spinal surgery, kyphoplasty patients generally are able to return home the same day as the surgery, or the day after, Dr. Mazagri said.
Vertebroplasty uses a similar, minimally invasive technique but doesn't employ a balloon.
"It stabilizes the fracture and reduces the pain but doesn't restore the patient's height," Dr. Mazagri said.
Patients with vertebral fractures caused by osteoporosis only have any type of surgery after more conservative treatment, including medication and use of a brace, he said.
"For patients who need surgery, kyphoplasty lessens the pain, reduces the deformity, restores the height of the body, and improves the quality of life," he said.
How kyphoplasty works to repair vertebrae
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A normal vertebra, showing full, 'normal' height.
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A fractured vertebra. Fractures may happen as a result of osteoporosis, or bone-thinning. The condition is most common in the elderly.
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In kyphoplasty,
the surgeon works through two small incisions to create narrow pathways into the fractured bone and inserts two KyphX balloons.
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The KyphX balloons are inflated, moving the collapsed portion of the vertebra. The purpose is to restore the fractured bone to its original shape.
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Once the doctor has achieved the desired result, the KyphX balloons are deflated and removed. The surgeon can then fill the space with special cement.
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Osteoporosis and spine fractures
Osteoporosis is a disease characterized by low bone mass and structural changes that cause bones to become fragile and easily broken. About 10 million Americans -- 80 percent of them women -- have osteoporosis and an estimated 44 million have low bone mass, putting them at risk for developing osteoporosis.
Though it generally occurs with advancing age, particularly in women, osteoporosis may also be caused by use of particular medications such as corticosteroids.
Osteoporosis causes more than 1.5 million fractures each year. While people often associate osteoporosis with broken hips, bone thinning actually causes more than twice as many fractures of the spine than hip fractures.
"There are about 700,000 spine fractures from osteoporosis each year," Dr. Mazagri said. "Twenty percent of people over 70 have some form of fracture."
Vertebral compression fractures can cause long-term consequences, including chronic, debilitating pain, impaired physical function, decreased pulmonary function and increased mortality.
Fortunately, steps can be taken to prevent osteoporosis, detect it before it becomes symptomatic and treat it.
The best prevention is to build up bone mass prior to age 30 through adequate calcium and vitamin D intake, weight-bearing exercise, and a healthy lifestyle without smoking or excessive alcohol intake.
Bone density tests, available through many local physicians, can detect osteoporosis, help predict chances of fractures and determine the rate of bone loss. If osteoporosis or its precursor, osteopenia, is detected, medications may be used to reduce the bone loss.