South Florida Hospital News
Tuesday August 11, 2020
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January 2005 - Volume 1 - Issue 6
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Patients Benefit from Spinal Fracture Surgery

For years, people suffering from spinal fractures didn't have a lot of options when it came to the treatment of their condition. They could take pain medications, wear a back brace, or limit their activity so as not to cause further damage. Today, there is a new option available for the treatment of osteoporosis-related fractures called balloon kyphoplasty; a minimally invasive surgery that is becoming more popular among both patients and practitioners.

"Balloon kyphoplasty is actually a very common procedure here in Florida," explained Dr. Mark Eskenazi, a spinal surgeon who works primarily at Delray Medical Center. "We have a large elderly population, and most compressions fractures are usually found in the Medicare-aged population."

The surgery, which was approved by the Food and Drug Administration in 1998, is most often used to treat patients with acute or sub-acute fractures. "Most of our patients have suffered from a fall or a minor trauma that's causing them back pain," explained Dr. Eskenazi, who has performed more than 250 of the procedures. "They might have hurt themselves lifting something, or have a twisting injury. If the pain doesn't go away, they need to see a physician."

Left untreated, spinal fractures can cause a myriad of problems, including chronic pain, loss of height, breathing problems, difficulty in walking and loss of appetite. Vertebral compression fractures, or VCFs, can cause curvature of the spine, often known as 'dowager's hump,' and can also cause even more bones to compress upon each other. After one fracture, a patient's risk of future fractures is increased five-fold.

To date, approximately 90,000 vertebral compression fractures have been treated using the kyphoplasty procedure, with more than 2,700 physicians trained to do the procedure in the United States. During the procedure, a surgeon makes small incisions in the back, through which he or she inserts a narrow tube into the vertebrae using X-ray guidance. A balloon, like those used in cardiac angioplasty, is inserted through the tube into the fractured vertebral body.

"We gradually inflate the balloon, which elevates the fracture and uncollapses the bone," explained Dr. Eskenazi. "This also creates a void within the spinal bone. After we deflate and remove the balloon, we fill this voice with medical-grade cement, like the type used in hip and knee replacements."

According to Dr. Eskenazi, the procedure itself takes roughly 20 to 30 minutes to perform, and is done with a local or general anesthetic. The surgery can be done on an outpatient or inpatient basis, with most patients able to go home the same day of the procedure.

"This surgery really doesn't cause much disruption in a patient's life," he explained. "And very often, patients notice immediate pain relief." Dr. Eskenazi notes that between 80 to 85 percent of the patients who have the surgery experience a significant amount of pain relief, and that complications, such as infection and nerve damage, are exceedingly rare.

According to the National Osteoporosis Foundation, more than 700,000 spinal fractures occur annually in the United States, with approximately 260,000 patients diagnosed with their first VCF each year. Eighty-three percent of these fractures are due to osteoporosis, with 14 percent related to trauma and 3 percent the result of cancer. Fractures can also be caused as a result of chronic steroid use to treat diseases such as lung cancer.

For patients who are at-risk of developing a number of spinal fractures, like those on certain medications, this surgery is especially important. "In patients taking steroids for chronic conditions, you often see multiple fractures," said Dr. Eskenazi. "Left untreated, these fractures can continue to compress, causing spinal deformity. But with the surgery, we can treat these multiple fractures as they occur."

In addition to performing the surgery, Dr. Eskenazi also works to educate primary care physicians (PCPs) and other medical professionals about the benefits of balloon kyphoplasty. "In this area, people talk about medical issues a lot, so they are probably more aware of it," he explained. "But in other areas, it is not as commonly discussed, so I try to make PCPs and rheumatologists aware that is available."

In most cases, the surgery is covered by Medicare, and some personal insurance companies also reimburse for the procedure. "People with this kind of back pain don't need to grin and bear it," said Dr. Eskenazi, who added that most spinal fractures can cause months of pain, as well as continued compression while patients wait for the fractures to heal. "There is a major downside to leaving this condition alone."

Dr. Eskenazi can be reached at (561) 381-4271.
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