Most patients referred to Virginia Interventional and Vascular Associates (VIVA) for vertebroplasty or a related procedure, kyphoplasty, experience rapid pain relief from vertebral compression fractures. Interventional radiologists use imaging guidance to inject medical-grade bone cement into the fractures, thereby stabilizing the collapsed vertebra.
“Many of our patients have complete relief immediately after the procedure, and most have relief within 48 hours,” said R. Donald Doherty Jr., MD, of VIVA, the interventional radiology and vascular surgery division of Radiologic Associates of Fredericksburg.
Dr. Doherty and Dr. John McLaughlin of VIVA have performed the same-day procedures for more than 291 patients since September 2003, with 471 vertebral bodies treated. Both doctors are board-certified interventional radiologists with training in vertebroplasty and kyphoplasty.
Patients are referred to VIVA by orthopedic surgeons, neurosurgeons, family practitioners, and internists and, in some cases, are self-referrals. The typical patient is an elderly female with osteoporosis whose pain from compression fractures has not responded to conventional therapies, such as bed rest and analgesics. Patients with compression fractures due to bone tumors, trauma, or “soft” bones from long-term steroid use or other conditions also are candidates.
Studies have demonstrated that the procedures offer long-term pain relief with a low complication rate, according to the Society of Interventional Radiology (SIR). One recent landmark study, published in The Lancet March 21, 2009, compared the efficacy and safety of kyphoplasty with non-surgical care in a randomized controlled trial involving 300 patients at 21 sites in eight countries. The study assessed patients one month after the procedures and found that patients receiving kyphoplasty experienced 2.5x greater improvement in performing daily activities and 3x faster pain relief than non-surgical patients. The frequency of adverse effects was comparable and low in both groups.
“Our findings suggest that balloon kyphoplasty is an effective and safe procedure for patients with acute vertebral compression fracture and will help to inform decisions regarding its use as an early treatment option,” the authors wrote.
The study should encourage physicians to consider these procedures among first- line treatments for vertebral compression fractures, according to Dr. Doherty.
“Typically, patients with compression fractures experience a downward spiral. If they have a back fracture and are in pain, they cannot take care of themselves, and there is a continuous loss of independence and capabilities. If the medical community intervenes early, we can interrupt this spiral and get patients back on their feet,” Dr. Doherty said.
Recently, two studies in the New England Journal of Medicine August 6, 2009 showed vertebroplasty to be equivalent to a placebo control arm using a local anesthetic. SIR and the Society of NeuroInterventional Surgery are analyzing the studies and plan to respond in a future issue of the NEJM, according to a statement by SIR. Dr. Doherty said a number of interventional radiologists are concerned that patients who participated in the recent studies were much more ambulatory than patients typically treated with vertebroplasty. There also have been questions about the small size of the study groups, noted SIR.
VIVA’s doctors perform the minimally invasive procedures in the radiology operating suite at Mary Washington Hospital. The procedures are similar, but kyphoplasty also involves the use of tiny balloons to decrease curvature of the back, Dr. Doherty said. The balloons are removed before injecting the fracture with medical-grade bone cement.
Patients receive conscious sedation before the procedures. Then the interventional radiologist inserts a needle through the skin and, with the aid of X-ray images, guides the needle into the fractured vertebra. The interventional radiologist then injects bone cement into the site of the fracture. The entire procedure takes from one to two hours to perform in cases involving three or fewer bones, Dr. Doherty estimated. The cement hardens within 15 minutes, creating what has been likened to an “internal cast” that stabilizes the fracture.
Patients are discharged the same day, and can usually return to normal activities immediately. Most insurance plans cover vertebroplasty and kyphoplasty, SIR reports.
Contraindications for the procedure are relatively few, but include severe fractures with neurological complications and active infections.
For more information, contact R. Donald Doherty Jr., MD at firstname.lastname@example.org or John J. McLaughlin, MD at email@example.com or call (540) 361-1000 and leave a message for the doctors.