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Osteoporotic fractures are common in the elderly and particularly in postmenopausal women but they can also be associated with other factors such as prolonged use of steroids. Some of the most debilitating are vertebral compression fractures (VCFs) which occur in the lumbar (lower) and thoracic (middle) spine. These occur when a vertebra collapses in on itself forming a wedge shape which reduces height and increases curvature of the spine. The National Osteoporosis Society estimates that around 120,000 VCFs occur each year in the UK and this figure is set to rise by a quarter in the next 8 – 10 years due to our ageing population.
Up to 40% of patients suffering a VCF will have constant pain while the risk of having another vertebral fracture is increased fivefold. Despite this, many patients are managed conservatively with pain relief because the standard surgical solution has been a major open operation on the spine with up to a 10% complication rate.
Now a new minimally invasive procedure is available which is suitable in up to a third of VCF cases. The procedure, known as balloon kyphoplasty, involves making a small incision in the patient’s back through which one or two balloon devices are inserted into the crushed vertebra. Once it is in position, the balloon which is filled with a radio-opaque contrast liquid so it can be clearly visualised under X-ray, is slowly inflated to restore as far as possible the original height of the vertebra. The balloon is then deflated and withdrawn and the cavity created is filled with bone cement to stabilise the fracture.
The new procedure has several advantages for patients: the length of stay in hospital is reduced from five days to one day and the rate of complication is reduced from 10% to between 0.5% and 1%. Pain relief is immediate; the restoration of the vertebral structure regains some of the height lost and, importantly, this reduces the curvature of the spine and the pressure put on the adjacent vertebrae which now have a lower risk of themselves suffering compression fractures.
Animation courtesy Kyphon Inc.
The procedure was approved by the National Institute for Clinical Excellence (NICE) in April 2006 and is offered at St Anthony's by Consultant Orthopaedic Surgeon Mr Michael Kotrba.
To book an appointment call 020 8335 4678 / 79