1905 Clint Moore Rd. Suite #309
Boca Raton, Florida 33496
Phone: (561) 988-8988
Fax: (561) 988-7075
VERTEBRAL AUGMENTATION (VERTEBROPLASTY & KYPHOPLASTY)
What Is It?

Vertebroplasty and kyphoplasty both involve the injection of bone cement (polymethyl-methacrylate), directly into the painful compression fracture of the spine through a single small needle. This treatment typically takes about 8 to 15 minutes and provides immediate pain relief in about 90% of those treated. There may be some post procedure discomfort from the needle passing through soft tissues, but most patients feel better immediately, and the spine feels more stable. They can walk, stand and sit up without the mechanical component of pain, as soon as the cement hardens in about five minutes after the injection. The compression fracture is stabilized by the hardened cement immediately. A biopsy is often performed to identify any unknown cancerous disease of the bone, that caused the bone weaking resulting in the fracture.

Kyphoplasty involves additionally the utilization of a balloon to open the fracture, regain and restore some or most of the pre-fracture height of the collapsed fracture vertebra, followed by an injection of the cement in the same fashion as the vertebroplasty.
Vertebroplasty and Kyphoplasty Advantages

1. Quickly relieves pain, rather than awaiting the normal several months of the natural, slow healing process of a vertebral bone compression fracture.

2. Achievement of improved vertebral body height and often times reversal of collapse, improving posture with the ability to stand straighter again,

immediately after the procedure.

3. Prevents the fracture from collapsing any further (which can occur even in a brace).

4. Immediate resumption of physical activity, such as walking.

5. Eliminates costly back braces, which work poorly for these fractures, and further narcotic pain medications are usually not needed.

6. Reduces generalized muscle atrophy by early resumption of activity.

7. By decreasing the pain, patients can experience improved mobility after the procedure which can possibly decrease the progression of osteoporosis.
History

Vertebroplasty has been performed since about 1985 in France, where it was developed, and in the United States for about 12 years now. Dr. Fernyhough and Dr. Lowen at the Florida Back Institute perform the most vertebroplasties of any clinic in the United States at this time – usually several procedures each day, and therefore, have the most combined experience and advanced equipment available. The bone cement has been used for over 40 years in hip and knee replacement surgery.

Kyphoplasty is a later modification of the vertebroplasty with the addition of a balloon inserted through the outer needle and, upon inflation, elevates the endplates of the compressed vertebral body to straighten out the spine more effectively. It has been refined with smaller needles to the point it can now be performed in an outpatient setting under local anesthesia alone.
Compression Fractures

These fractures typically occur in the elderly osteoporotic spine, sometimes with a minimal fall or even with no known injury. There are about 700,000 of these painful fractures yearly in the United States, and many more, which are not painful. They can range from minimal pain to severe, disabling pain, which cannot be alievated by either strong narcotic medications or back braces. Most compression fractures heal spontaneously in 2 to 6 months.

However, some of these fractures are very painful and disabling, producing significant physical limitations for the elderly affected and are not helped by back braces, which are poorly tolerated, or narcotic pain medications with their adverse side effects such as confusion, constipation, loss of appetite, etc. These fractures if left untreated can lead to a permanent spinal deformity, including a forward leaning postural malalignment and inability to stand erect. Vertebroplasty and kyphoplasty procedures offer about  a 90% chance of significant (usually complete) pain relief with few complications.


New Fractures

New fractures may occur in any person who has already experienced a compression fracture. About 1 in 4 (25%) will do so, within the first 12 months; this is about the same percentage as those without vertebroplasty or kyphoplasty treatment. This rate of re-fracture (25% within the first 12 months) is considered the natural history of osteoporosis fractures.
Osteoporosis Management

This involves several measures:

Diagnosis is made by a Dexa-Scan – bone densitometry of the hips and spine is used to identify osteoporosis and its severity, and to follow its progress or improvement.

1. Calcium supplementation, 1500 mg per day in post-menopausal females.

2. Exercise by walking 20 minutes twice daily.

3. Medical management by your medical doctor, particularly considering new drugs such as Reclast yearly injection, Forteo daily injections or pills such as Fosamax, Evista and others. Ask your internist, rheumatologist or endocrinologist for more information.

4. Kyphoplasty/vertebroplasty – for those painful compression fractures associated with intolerable pain and to prevent further collapse and deformity and further osteoporosis by resuming early more pain-free activities immediately.
Risks and Warnings

1. Many fractures can be missed on plain x-ray. MRI is the best way to diagnose stress fractures not seen on plain x-ray.

2. Possible infection, nerve damage, continued pain or additional fractures are possible because the remaining osteoporotic spine bones are still weakened and susceptible to fracture with injury or even just normal weightbearing activities.

3. Possible adverse reaction (including death) to the cement is very rare and has never occurred in our practice.

4. Persisting back pain after vertebroplasty or kyphoplasty can occur from the needle/bone penetration, muscular strain, kyphosis angulation, soft tissue disruption, or most commonly, due to new fractures.

5. There is no guarantee that vertebroplasty, kyphoplasty, or any other medical procedure is 100% successful or safe. All procedures carry some rare and unknown risks.

6. Bone cement (PMMA) is now FDA approved for vertebroplasty and kyphoplasty in a pre-mixed preparation with sterile barium contrast for safer, laser- guided fluoroscopic visualization during injection.

7. Possible rib fractures, lung collapse, disk or vein injection, thermal injury, etc.

8. Overall complication rate less than 1%.

9. Some compression fractures can later collapse further, even after the vertebroplasty or kyphoplasty, and may need revision with additional cement injection.

ANTI-PLATELET MEDICATIONS

Are you taking any of the following medications, vitamins or herbs:

1. Aspirin
2. Vitamin E
3. Motrin
4. Advil
5. Ibuprofen
6. Aleve
7. Naprosyn
8. Ecotrin
9. Baby Aspirin
10. Feldene
11. Lodine
12. Voltaren
13. Arthrotec
14. Daypro
15. Excedrin
16. Indocin
17. Cataflam
18. Relafen
19. Trilisate
20. Ticlid
21. Persantine
22. Orudis
23. Fiorinal
24. Agrylin
25. Pletal
26. Aggrenox
27. Effient
28. Pradaxa
29. Coumadin
30. Warfarin
31. Plavix
32. Xarelto

Please be sure your physician has allowed you to be off aspirin/Ecotrin/baby aspirin/Plavix/Aggrenox/Effient for one week (7 days), or off Coumadin/Warfarin for 3 to 5 days, or off Pradaxa/Xarelto for 3 doses in a row, in preparation for epidural injection.
Post-Procedure

Take it easy, apply ice and heat, for local pain relief and you may take pain medications. You should walk and stand, but avoid heavy lifting, bending or twisting and sports for several weeks to allow spontaneous healing around the stabilized cemented fracture. After the kyphaloplasty/vertebroplasty call our office at (561)-988-8988 immediately if any unexpected or severe new pain develops.
MOST COMMONLY ASKED QUESTIONS ABOUT VERTEBROPLASTY AND KYPHOPLASTY

What is vertebroplasty?
Vertebroplasty is a 15- minute procedure performed in our office to minimize fracture pain and prevent further collapse of the vertebra. It is done in our office, under local anesthesia, in which bonce cement is injected into the fractured vertebra. In some cases, a bone biopsy is performed.

When will I feel better?
Some people feel better immediately; others need 10 to 14 days to fully heal the soft tissue where the needle was placed. Others may still have pain from spinal stenosis, disk herniations, and other degenerative spinal conditions, that were present before the fracture occurred.

Why should I do vertebroplasty or kyphoplasty?
It relieves pain by stopping motion in the fractured bone and also prevents further collapse of the vertebra, and it restores the height of the fractured, collapsed vertebral body.

Where did the procedure come from?
It was first performed in Paris, France in 1984. The first paper ever published in the United States was in 1997. It is now done in every modern city in the world.

How many vertebroplasties have Dr. Lowen and Dr. Fernyhough performed?
They do approximately 600 cases per year combined.

What happens if severe pain resumes?
Research has shown that 1 in 4 (25%) of patients who have a single fracture will re-fracture a different level within the first 12 months. This is the natural history of osteoporosis and not thought to be caused by vertebroplasty or kyphoplasty. If severe pain returns , please contact our office immediately.