Kyphoplasty for the Treatment of Vertebral Compression Fractures Jessica Brock Advised by Sam...
-
Upload
hector-lloyd -
Category
Documents
-
view
220 -
download
0
Transcript of Kyphoplasty for the Treatment of Vertebral Compression Fractures Jessica Brock Advised by Sam...
Kyphoplasty for the Kyphoplasty for the Treatment of Vertebral Treatment of Vertebral Compression FracturesCompression Fractures
Jessica BrockJessica Brock
Advised by Sam PowdrillAdvised by Sam Powdrill
Vertebral Compression Vertebral Compression FracturesFractures
The most common complication of The most common complication of osteoporosisosteoporosis
Estimated 700,000 VCFs occur annuallyEstimated 700,000 VCFs occur annually200,000 are refractory to medical management200,000 are refractory to medical management Cost $10-15 billion annuallyCost $10-15 billion annually
Can result in spinal deformity: Can result in spinal deformity: kyphosis/lordosiskyphosis/lordosis
Cause acute and chronic pain leading to Cause acute and chronic pain leading to disabilitydisability
Cause of reduced vital capacityCause of reduced vital capacity
The Downward SpiralThe Downward Spiral
OsteoporosisOsteoporosis VCFsVCFs Spinal DeformitySpinal Deformity Decreased lung Decreased lung
capacitycapacity Decreased physical Decreased physical
functionfunction Early SatietyEarly Satiety
Sleep problemsSleep problems Decreased activityDecreased activity More bone lossMore bone loss Increased fracture Increased fracture
riskrisk Decreased Decreased
pulmonary functionpulmonary function Increased mortalityIncreased mortality
PreventionPrevention
Bone Density Testing in women > 65 Bone Density Testing in women > 65 year, men > 70 yearsyear, men > 70 years
Adequate intake of calcium, vitamin Adequate intake of calcium, vitamin D, and regular weight bearing D, and regular weight bearing exerciseexercise
Pharmacology: bisphosphonates, Pharmacology: bisphosphonates, calcitonin, SERMScalcitonin, SERMS
Reduce the risk of fallingReduce the risk of falling
Signs and SymptomsSigns and Symptoms
Consider VCF in any patient > 50 Consider VCF in any patient > 50 years if they complain of acute or years if they complain of acute or chronic back painchronic back pain
Get a AP and lateral x-ray of the spineGet a AP and lateral x-ray of the spine Look for wedge shaped vertebral Look for wedge shaped vertebral
bodiesbodies MRI with T2 sequence shows state of MRI with T2 sequence shows state of
fracture healingfracture healing
Conservative TherapyConservative Therapy
NSAIDSNSAIDS OpiodsOpiods Muscle relaxantsMuscle relaxants Bed restBed rest Orthotic bracingOrthotic bracing VCF healing should occur in 6-12 VCF healing should occur in 6-12
weeksweeks Refractory in 15-20% of patientsRefractory in 15-20% of patients
KyphoplastyKyphoplasty
Minimally-invasiveMinimally-invasive PercutaneousPercutaneous Can restore lost vertebral heightCan restore lost vertebral height Immediate pain reductionImmediate pain reduction Fewer complications compared to Fewer complications compared to
vertebroplastyvertebroplasty By 2005, performed on 170,000 By 2005, performed on 170,000
patientspatients
KyphoplastyKyphoplasty
2 fluoroscopy units for visualization2 fluoroscopy units for visualization Patient is supported in prone positionPatient is supported in prone position 4 cm bilateral incision via the 4 cm bilateral incision via the
pedicles using trocar, guidewire, pedicles using trocar, guidewire, cannula, bone tamp, cementcannula, bone tamp, cement
Maximum of 3 vertebral bodiesMaximum of 3 vertebral bodies
ComplicationsComplications
Cement ExtravasationCement Extravasation– Pulmonary embolismPulmonary embolism– AbscessesAbscesses– Disc damageDisc damage
Adjacent VCFs post surgery—20-30%Adjacent VCFs post surgery—20-30% General complication rate 1-2%General complication rate 1-2%
ConclusionsConclusions
Kyphoplasty is a safe and effective Kyphoplasty is a safe and effective treatment for back pain due to treatment for back pain due to osteoporotic VCFs.osteoporotic VCFs.
Providers should include kyphoplasty Providers should include kyphoplasty in the discussion of options for the in the discussion of options for the VCF patientVCF patient
Reimbursement available by Medicare Reimbursement available by Medicare and private insurance companiesand private insurance companies
ReferencesReferences ACP medicine, Dale, D, and Federman, D. 3rd edition. WebMD Professional Publishing. ACP medicine, Dale, D, and Federman, D. 3rd edition. WebMD Professional Publishing. New York, NY. 2007, Vol. I, 707-711New York, NY. 2007, Vol. I, 707-711 Albertico, RA. Balloon Kyphoplasty for Multilevel Spinal Metastases from BreastAlbertico, RA. Balloon Kyphoplasty for Multilevel Spinal Metastases from Breast Cancer. J Support Oncol 2007;5:243-246Cancer. J Support Oncol 2007;5:243-246 Garfin, SR, Buckley, RA, and Ledlie, J. Balloon kyphoplasty for symptomatic vertebral Garfin, SR, Buckley, RA, and Ledlie, J. Balloon kyphoplasty for symptomatic vertebral body compression fractures results in rapid, significant, and sustained body compression fractures results in rapid, significant, and sustained improvements in back pain, function, and quality of life for elderly patients. improvements in back pain, function, and quality of life for elderly patients. Spine, 2006. 31(9), p.2213-20.Spine, 2006. 31(9), p.2213-20. Hanna, J, and Letizia, M. A treatment for osteoporotic vertebral compression fractures. Hanna, J, and Letizia, M. A treatment for osteoporotic vertebral compression fractures. Orthopedic Nursing. Vol 26(6). 2007. pg 342-346.Orthopedic Nursing. Vol 26(6). 2007. pg 342-346. Harrison, AL. Changes in the Bone Associated with Aging. Lecture at the University of Harrison, AL. Changes in the Bone Associated with Aging. Lecture at the University of Kentucky. Summer 2007.Kentucky. Summer 2007. Howland, RD, and Mycek MJ. Howland, RD, and Mycek MJ. PharmacologyPharmacology. 3rd edition. Lippincott Williams & . 3rd edition. Lippincott Williams & Wilkins. Philadelphia. 2006.Wilkins. Philadelphia. 2006. Ledlie, JT and Renfro, MB. Kyphoplasty treatment of vertebral fractures: 2-year Ledlie, JT and Renfro, MB. Kyphoplasty treatment of vertebral fractures: 2-year outcomes show sustained benefits. Spine, 2006. 31(1): p.57-64outcomes show sustained benefits. Spine, 2006. 31(1): p.57-64 Pateder, DB, Khanna AJ, and Lieberman, IH. Vertebroplasty and Kyphoplasty for the Pateder, DB, Khanna AJ, and Lieberman, IH. Vertebroplasty and Kyphoplasty for the Management of Osteoporotic Vertebral Compression Fractures. Orthop Clin NManagement of Osteoporotic Vertebral Compression Fractures. Orthop Clin N Am 38 (2007) 409-418.Am 38 (2007) 409-418. Robinson, Y., Tschoke, SK., Stahel, PF, Kayser, R., and Heyde, CE. Complications and Robinson, Y., Tschoke, SK., Stahel, PF, Kayser, R., and Heyde, CE. Complications and safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective safety aspects of kyphoplasty for osteoporotic vertebral fractures: a prospective follow-up study in 102 consecutive patients. Patient Safety in Surgery 2008, 2:2.follow-up study in 102 consecutive patients. Patient Safety in Surgery 2008, 2:2. Surgeon General’s Report on Bone Health and Osteoporosis. 2004.Surgeon General’s Report on Bone Health and Osteoporosis. 2004. Taylor, RS, Fritzell, P, and Taylor, RJ. Ballon kyphoplasty in the management of Taylor, RS, Fritzell, P, and Taylor, RJ. Ballon kyphoplasty in the management of vertebral compression fractures: an updated systematic review and meta-analysis. vertebral compression fractures: an updated systematic review and meta-analysis. Eur Spine J (2007) 16:1085-1100.Eur Spine J (2007) 16:1085-1100. Vajnar, J. Compression Fractures in a Man with Osteoporosis. JAAPA Sept 2007, 20(9).Vajnar, J. Compression Fractures in a Man with Osteoporosis. JAAPA Sept 2007, 20(9). Resources:Resources: National Osteoporosis Foundation www.nof.orgNational Osteoporosis Foundation www.nof.org Kyphon, Inc. Sunnydale, CAKyphon, Inc. Sunnydale, CA