Balloon Gives Lift to Surgery Repairing Fractured Vertebrae

A new procedure at Ohio State University Medical Center relieves the severe pain of broken vertebrae and restores height to hunched-over patients " all thanks to a tiny balloon.

The procedure, called balloon kyphoplasty, is a minimally invasive method of injecting bone cement directly into broken vertebrae involving just two small puncture incisions and allowing patients to make a rapid return to daily activities. The balloon provides the added benefit of lifting the affected vertebra back to its normal position before the cement is inserted.

"Good candidates for this procedure would be elderly women with a compression fracture caused by osteoporosis. These women often develop a deformation over time that hunches them forward. We fix the fracture, relieve their pain and restore upright posture," said Dr. Louis Caragine, a neurosurgeon and director of endovascular neurosurgery at Ohio State's Medical Center.

"The advantage is putting the balloon directly into the bone, which expands and elevates the vertebra from a flattened pancake shape to a level closer to normal alignment for the patient. It's a new way to handle compression fractures that are causing severe pain not relieved by medication," Caragine said.

During the procedure, the surgeon inserts two trocars " narrow, hollow pointed instruments " into the spine to create a pathway to each side of the fractured bone. The small balloon is guided through each instrument into the vertebra and inflated to raise the collapsed vertebra and create a cavity within the bone. The cavity is filled with cement to support surrounding bone and prevent further collapse. Fluoroscopy " a live-action X-ray " and intraoperative computerized tomography allow the surgeon to ensure the instruments are properly placed within the bone.

"The treatment for these patients used to be requiring them to wear a brace for three months. The bone would heal that way as well, but kyphoplasty significantly accelerates the process," Caragine said.

He noted that patients first must be evaluated to be sure their pain is caused by a vertebral fracture and not compression of the spinal cord itself, which requires a different, more invasive surgical repair.

An estimated 44 million Americans either have or are at risk for osteoporosis, which contributes to about 700,000 spinal fractures in the United States each year.

Though osteoporosis patients are the most common beneficiaries of this procedure, patients whose spinal columns have been damaged by cancer also can benefit.

"With the latest advances, we're becoming more aggressive and also will perform balloon kyphoplasty on cancer patients as long as there is no cord compression from a tumor. While we're accessing the spine, we're able to take a bone biopsy that we can send to the pathology lab to be sure there's proper follow-up treatment if the patient has metastatic disease of the spine," Caragine said.

Symptoms of a compression fracture include severe low- to mid-back pain that is not relieved by over-the-counter pain medication. It can also be caused by a trauma.