JEDDAH, 11 October — The traditional treatment for spinal fractures because of osteoporosis included pain reduction by medication, bed rest and bracing. In 1984, a surgical technique designed to reduce the pain and loss of function called ‘Percutaneous Vertebroplasty’ was developed in France. An improvement to this technique was developed in 1998 in the US. It entailed using a special balloon, the KyphX Inflatable Bone Tamp, to reduce the fragility of fractured bones and help them heal by creating a cavity in the soft inner bone of the vertebra
Osteoporosis - the loss of calcium from bones which results in weakened bone structure — increases the risk of fracture of the vertebral body (the thick block of bone at the front of the vertebrae). In this type of fracture, the top of the vertebral body collapses in front thus producing the ‘wedged’ vertebrae — or the ‘dowagers’ hump’. The resulting change in height and spinal alignment can lead to serious health problems including chronic or severe pain, limited function and reduced mobility, loss of independence in daily activities, decreased lung capacity, and difficulty sleeping. Studies have also shown that a first osteoporotic fracture makes it five times more likely that further fractures will occur. That is why it is important for patients to seek medical treatment for osteoporosis before it reaches the stage of fractures.
“Osteoporosis is prevalent in Saudi society,” said Dr. Marwan Najjar, consultant neurosurgeon, “and there is too little awareness about prevention and treatment.” He estimates that some 70% of women over 50 and 15% of men suffer from it. Osteoporosis itself does not cause back pain; it can, however, weaken the vertebral body (spine) so that the spine can no longer withstand normal stress or a minor trauma such as a fall which may cause a fracture. Both vertebroplasty and kyphoplasty are minimally invasive surgical procedures for treating osteoporotic fractures. A cement-like material (artificial bone) is injected directly into the fractured bone. This stabilizes the fracture and provides immediate pain relief in many cases. Kyphoplasty includes an additional step. Before injecting the cement-like material, a special balloon is inserted and gently inflated inside the fractured vertebrae. The goal is to restore height to the bone thus reducing deformity of the spine.
Approximately 500 patients have undergone the new procedure in the US since the balloon’s approval by the FDA in 1998. Kyphoplasty was performed for the first time at Dr. Erfan and Bagedo Hospital almost three months ago by Dr. Najjar. “It was performed on a middle-aged woman who was physically assessed to be a good candidate for the procedure,” said Dr. Najjar. Pain relief will be immediate for some patients and recovery time is a day or two. “The patient was able to walk without pain within two days,” said Dr. Najjar.
There are some general surgical risks that apply to kyphoplasty including a reaction to anesthesia and infection. There are other risks that are specific to this procedure. “That is why this procedure has to be performed by trained and specifically certified surgeons,” said Dr. Najjar.
Because it is still a fairly new procedure, it costs more than vertebroplasty but the outcome is better according to Dr. Najjar. After either procedure, however, patients need to see their physician to begin or review their treatment plan for osteoporosis, including medications to prevent further bone loss and fractures which would require another surgery.
