Kyphoplasty miracle for the elderly with Spinal Fractures

Mr. Nagesh (name changed), aged 83-years had an accidental slip and fall at home and was unable to get up and even the slightest of movement was very painful in his mid-back. He was taken to the nearby hospital and was diagnosed with wedge compression fracture L1. He was suggested bed rest for 6 weeks and put on anti-osteoporosis medications. After 6-weeks, the patient hardly felt any change in his symptoms and was still unable to even change his position on bed. He was continued on bed rest for another 6 weeks and when his condition was unchanged, he was motivated to take a second opinion. At Manipal Hospital, he was evaluated by an MRI to find that his spinal fracture had not healed. Taking into consideration his age and co-morbidities, the general anesthesia was risky. He was offered an option of Percutaneous Balloon Kyphoplasty under Local Anesthesia and Sedation. He underwent the proposed procedure with complete relief of pain in two hours post-surgery and was able to walk independently. He was discharge home on the same evening. Presently he is going to a nearby park and taking a walk on a daily basis.

Osteoporosis has become a major public health concern worldwide. It is believed that the associated healthcare costs are growing in parallel with increase in elderly population, and it is expected that the number of osteoporotic fractures will double over the next 50 years. The global incidence of osteoporotic spinal compression fractures, also known as vertebral compression fractures (VCFs), is currently estimated at 7,00,000 annually and is expected to increase fourfold over the next 50 years.

VCFs are the most common fractures in patients with osteoporosis. They occur when the bones of the spine break due to trauma, and affect an estimated 25 per cent of all post-menopausal women in the US. VCFs occur in two age groups with different causes. In old people, the commonest cause is osteoporosis of bones followed by metastatic cancers from breast and prostate. In the young, it occurs due to traumatic injury to spine due to vehicular accidents and fall from height.

Kyphoplasty, well known as Percutaneous Balloon Kyphoplasty, is a minimally invasive procedure where balloons are first introduced into the fractured vertebral body through a needle. These balloons are then inflated under pressure to correct the collapse/deformity and create a cavity. Bone cement is then introduced through the same needle into the cavity already created to maintain the position and hold the fractured bone pieces together.

Kyphoplasty treats spinal compression fractures by stabilizing the fracture and reducing back pain. It has additional benefit of restoring vertebral height. As it is a day-care procedure, it has possibility of minimal blood loss, almost immediate mobilization, no need of brace, better reduction of fracture and better control of pain under loading. The success rate of this procedure in relieving pain due to osteoporotic fractures exceeds 90 per cent.