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Minimally Invasive Spine Surgery Treats Fractures Associated with Osteoporosis

May 15, 2012

New Operating Room Offers Advanced Imaging Capabilities

Osteoporosis is the most common type of bone disease, affecting an estimated one in five women over the age of 50, according to the National Institutes of Health. It causes weak, brittle bones that break easily. Compression fractures in the spine due to osteoporosis can cause debilitating pain. Kyphoplasty is a relatively new minimally invasive spine surgery that repairs the fracture and alleviates the pain.

"A compression fracture in the spine occurs when one of the vertebrae is compressed, compacting and deforming the bone, which results in the spine curving forward," said Dr. Jan Henstorf, an orthopedic surgeon who specializes in minimally invasive spine surgery and is a member of Washington Township Medical Foundation as well as on the Washington Hospital medical staff. "The good news is the imaging technology in the new operating room at Washington Hospital has dramatically improved our ability to safely perform kyphoplasty procedures."

While men can develop osteoporosis, it is much more common in women. Osteoporosis occurs when the body does not form enough new bone or when too much old bone is reabsorbed by the body. Calcium and phosphorous are two minerals that are essential for the normal formation of bone. As you age, these minerals can be absorbed back into the body from the bones, which makes the bone tissue weaker, Henstorf explained. This can cause brittle, fragile bones that are more prone to fracture.

"From the time we are born until we are teenagers, our bodies add calcium to the bones," he added. "The bones are a warehouse for calcium. But once we reach maturity, the body starts removing calcium from the bones. That's why adults, particularly women, should increase their intake of calcium and vitamin D."

The leading causes of osteoporosis are a decrease in estrogen at the time of menopause for women and a drop in testosterone for men, according to the National Institutes of Health. That's why women over 50 and men over 70 are at higher risk for osteoporosis.

Sometimes people don't realize they have osteoporosis until they experience a fracture. A bone density test can measure how much bone you have so that your physician can predict your risk for bone fractures in the future.

The loss of bone happens gradually over time. There are no symptoms in the early stages of osteoporosis, but as the disease progresses it can cause bone pain and tenderness, fractures with little or no trauma, loss of height, lower back pain, neck pain, and stooped posture called kyphosis.

Kyphoplasty Offers Relief

"When the pain from a compression fracture is unmanageable or does not improve, it's time to do kyphoplasty," Henstorf said. "Kyphoplasty can relieve the pain and stabilize the fracture."

The procedure is performed through two tiny incisions in the patient's back, he explained. A needle is advanced through the vertebrae and a tiny tube is inserted with a balloon at the tip.

"The balloon is inflated with fluid, which pushes the compressed bone back toward its normal height, improving the deformity," Henstorf added. "When the fluid is removed from the balloon, it leaves behind a void. The void is filled with a type of bone cement that spreads into the pores of the bone and fills up the void. The bone cement hardens within minutes and supports the bone from the inside."

He said because the bone cement becomes hot as it hardens, it causes a minor injury to the nerve endings inside the bone, causing the nerves to no longer sense pain.

"The patient feels some pain where we inserted the needle, but the pain caused by the fracture is usually much improved," he said. "By the time the nerve endings repair themselves, the fracture has healed. This takes about three months."

According to Henstorf, imaging capabilities in the new operating room at Washington Hospital will make it much easier to see the bone and spine during the procedure. The operating room features a Body Tom portable 32-slice CT scanner, which provides three-dimensional images of the body right in the operating room. Washington Hospital is one of only three hospitals in the country to have the Body Tom.

"During kyphoplasty, we have to pass the needle though the skin, through the muscle, and into the bone," he explained. "The Body Tom gives us a three-dimensional view right in the operating room. It used to be that we had to take two x-rays each time we wanted to advance the needle. Now we can see the needle moving on a huge monitor in the operating room. We can safely advance the needle without taking multiple x-rays."

While there is no cure for osteoporosis, there are steps you can take to reduce your risk. Eating a diet with enough calcium, vitamin D, and protein can help. Regular exercise can also help to keep bones strong.

For more information about the Minimally Invasive Spine Program at Washington Hospital, visit www.whhs.com/neuroscience/spine.

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For more information about Washington Township Medical Foundation and its more than 60 board-certified physicians with expertise in a broad range of medical specialties - from neurosurgery to pediatrics - visit www.mywtmf.com or call (866) 710-9864.