When Ruth Kaufman fractured her spine, the pain threatened to end her
ballroom dancing days.
But a revolutionary medical procedure got her back on her feet and onto
the dance floor within a few weeks.
Kyphoplasty, a minimally invasive surgery performed at a handful of South
Florida hospitals, can alleviate up to 90 percent of the pain associated
with the vertebral compression fractures that often follow osteoporosis --
the bone disease that largely affects women after menopause.
About 700,000 people suffer from the fractures annually. For 260,000 of
them, the pain can be debilitating.
In such a fracture, the bony block, or vertebral body, in one of the
more than 20 vertebrae in the spine, collapses. This causes the spine to
curve into the dowager's hump associated with osteoporosis, a condition
doctors call ``kyphosis.''
With kyphoplasty, doctors use tiny balloons to create cavities in the
vertebral body and then fill them with plastic cement, which hardens and
acts as scaffolding for the collapsed bone. The cement boosts the
vertebral body to nearly original height, which eases the pain and may
straighten the spine.
``There are not that many things that we do that you see such dramatic
results,'' said Marc Kaye, chairman of radiology at Cleveland Clinic
Florida and one of about 180 doctors across the nation doing the
procedure.
Approved two years ago, kyphoplasty has been performed on about 1,000
patients nationwide.
Kaufman's husband, Seymour, can't believe the difference in his dance
partner.
``It's wonderful, because you get up and that's it,'' he said. ``Right
now there's no pain whatsoever, and we're having a good time on the dance
floor.''
The couple is from Aventura.
Before kyphoplasty, doctors had few means of treating the pain, other
than medication or bed rest. A similar procedure, which injects cement
into the vertebral body without first forming a cavity, is neither as safe
nor as effective, doctors say.
``Until now, we have had nothing to offer these people,'' said Frank
Phillips, a spine surgeon at the University of Chicago's Spine Center who
has studied kyphoplasty. ``Essentially, these patients were treated with
benign neglect. We really didn't have conventional treatment.''
Three years ago, Elizabeth McKnight of Boynton Beach would have been
one of these patients. Crippled by back pain after a vertebral compression
fracture, she relied on a walker to get around and took drugs to manage
her pain, which left her spacey and drowsy.
Last Friday, she became the fourth patient to undergo the procedure at
Fort Lauderdale's Cleveland Clinic Florida. Looking at an X-ray of her
back, Kaye pointed to a vertebral body compressed to a fraction of normal
height.
``It's like a pancake. There's not much bone there,'' Kaye said.
Under local anesthesia, the 78-year-old remained alert throughout the
procedure. She calmly lay on her stomach as Kaye and neurosurgeon Somnath
Nair carefully inserted needles into her back, making a path through which
they would send two tiny balloons.
The doctors paused frequently to check the needles' angles with
CT-scans and X-rays. The procedure requires careful monitoring as a needle
gone astray could puncture the spinal column, causing paralysis.
After they positioned the needles to their satisfaction, the doctors
inserted a tiny balloon and inflated it. No change was visible on
McKnight's back, but on the X-rays, the doctors could see the balloons
swell, bolstering the weakened bone.
They removed the balloons and injected a viscous cement into the holes
left behind.
The entire process took about an hour and a half, and by the end of the
day, McKnight had gone home. Patients can choose to remain hospitalized
overnight.
With vertebroplasty, the other method, doctors inject a more liquid
form of the bone cement directly into the vertebral body. This stabilizes
the fracture but does not elevate the bone. Because the liquid cement
spills, vertebroplasty carries a higher complication rate than kyphoplasty.
``This newer technique allows the cement to be more specifically
placed,'' said Kaufman's doctor, Jonathan Hyde, a spine surgeon at
Mount Sinai Medical Center in Miami Beach. ``From a surgical
standpoint, the control is very good.''
Because the procedure is relatively new, doctors still are trying to
determine the best time to perform it. Some believe it's wisest to strike
soon after the fracture. Others prefer to wait and see whether the pain
goes away without intervention.
``No one knows what's going to happen with the bones above and below
the level that's been injected,'' says Nathan Lebwohl, an associate
professor of orthopedic and neurological surgery at the University of
Miami's School of Medicine.
