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Kyphoplasty Richard M. Spiro, MD Michael Horowitz, MD

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Page 1: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Kyphoplastyyp p y

Richard M. Spiro, MDp ,Michael Horowitz, MD

Page 2: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Painf lPainful OsteoporoticOsteoporotic Compression Co p ess o

Fractures

Treatment Objectives & OptionsTreatment Objectives & Options

Page 3: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Orthopedic Fracture Care

Why have we been contentWhy have we been content to leave the spine in a

physiologically and biomechanically compromised condition?compromised condition?

Page 4: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

VCF Treatment Objectives

R i f Restoration of anatomy Early diagnosis and treatment for optimal 1

outcomes Special care for geriatric patientsp g p

–frail physical status and comorbidities

1 Colton, CL. Ch. 1 in Skeletal Trauma. 19982 Brakoniecki et al. Ch. 7 in Skeletal Trauma. 1998

Page 5: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

VCF Treatment OptionsManagement for Pain

M di l M

Management for Pain

Medical ManagementBed rest Narcotic analgesicsNarcotic analgesics Braces

Open Surgical Treatment

Vertebroplasty

Page 6: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Balloon KyphoplastyO i f T t t StOverview of Treatment Steps

1) Th b ll i i d i h f d b l b d1) The balloon is inserted into the fractured vertebral body

Page 7: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Balloon Kyphoplasty O i f T t t StOverview of Treatment Steps

2) h b ll fl d d h f d l h d l2) The balloon is inflated, reducing the fracture and elevating the endplates

Page 8: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Balloon Kyphoplasty Overview of Treatment StepsOverview of Treatment Steps

3) The balloon is deflated and withdrawn, leaving a cavity within the vertebra

Page 9: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Balloon KyphoplastyOverview of Treatment StepsOverview of Treatment Steps

4) The void is filled with KyphX® HV-R™ Bone Cement, creating an “internal cast”

Page 10: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyPatient: 73 YO FemaleDiagnosis: Primary OsteoporosisFracture Reduced: L1 6 months oldFracture Reduced: L1, 6 months old

Courtesy of Mohammad Majd, M.D., Jeffersonville, IN

Page 11: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyCase StudyPatient: 55 YO MaleDiagnosis: Secondary osteoporosisFracture Reduced: L-1, 3 day old

f l h lCourtesy of Ulrich Berlemann, M.D., Germany

Page 12: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Patient Selection d kand Work-Up

Page 13: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

DiagnosisDiagnosis

Identify painful levelIdentify painful levelDefine fracture configuration

Define fracture age

Osteoporotic Fracture?

Page 14: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

History and Physical ExamHistory and Physical Exam

Has there been a recent event, prior to onset of pain?

Does direct pressure on suspect vertebral bodies elicit pain?

Pain findings on physical exam should be concordant with radiographic findings.g p g

Some patients will have multiple painful vertebral bodiesbodies.

Page 15: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

X-Rayy

Older films (if available) may be useful to assess fracture

progression

Page 16: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyCase StudyPatient: 80 YO MaleDiagnosis: Steroid-induced osteoporosisFracture Reduced: T-8, 10 weeks old

Courtesy of Eeric Truumees, M.D., Southfield, MI

Page 17: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyCase StudyPatient: 75 YO FemaleDiagnosis: Primary osteoporosisFracture Reduced: L-3, 4 week old

Courtesy of Jonathan Hyde, M.D., Miami Beach, FL

Page 18: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

MRI T1 weighted shows high intensity for fat,

b t h t d G d li isubacute hematomas and Gadolinium enhanced substances T eighted sho s high intensit for T2 weighted shows high intensity for

conditions that increase free water, such as acute fractureacute fracture STIR MRI sequence is most sensitive for

water content when assessing fractureswater content when assessing fractures

Page 19: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

MRINotice the high signal intensity around the fracture

T2T1

Page 20: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

CT and Bone ScanCT and Bone Scan CT Scan

Diff ti t f t f th ft ti–Differentiates fat from other soft tissue–Shows structure of bone –Extremely high contrast between calcified structures (cortical and trabecular bone) and soft tissueEffectively limited to axial plane–Effectively limited to axial plane

Use CT plus Bone Scan to determine fracture when MRI cannot be used–Implantable metal devices

Page 21: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Balloon KyphoplastyBalloon KyphoplastySurgical Approaches and

Technique

Page 22: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Balloon Kyphoplasty Approaches

Transpedicular Extrapedicular

yp p y pp

p p

Both approaches are intended to be bilateral

Page 23: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

TRANSPEDICULAR APPROACH AccessAccess

Use fluoroscopy to locate the pedicle oca e e ped c ecutaneously

Place a small incision lateral and superior tolateral and superior to the cutaneous pedicle locationThi ill ll This will allow proper convergence through the tissues to the pedicle entry pointpedicle entry point

Page 24: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

TRANSPEDICULAR APPROACH Inflatable Bone Tamp InflationInflatable Bone Tamp Inflation

Place contralateral tools and IBTtools and IBT

Increase the volume in both IBTs in small (0.25-0.5 cc) incrementsA t i d Assess tamp size and position in lateral and AP views

Sequentially inflate until an inflation

d i i h dendpoint is reached

Page 25: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

VCF TreatmentCementingCementing

Deflate and remove IBTs

Insert BFD to within 3-5mm of anterior cortex5mm of anterior cortex

Under continuous fluoroscopy slowly inject the cement mix

Leave the bone void filler device anterior

Page 26: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

VCF Treatment Cementing APCementing AP

Final A-P view of cement fill

Cement fills in interstices of fractured boneof fractured bone

Page 27: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Balloon Kyphoplasty ExperienceExperience

Page 28: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Balloon Kyphoplastyyp p y

Since 1998Approximately 95,000 fractures

have been treated worldwidehave been treated worldwide

Page 29: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Patient OutcomesPatient Outcomes

Correction of Vertebral Body DeformityR d ti i P i Reduction in Pain Improvement in Quality of Life Improvement in Ability to Perform

Activities of Daily Livingy g High rates of Patient Satisfaction Low Complication Rate Low Complication Rate

Page 30: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Percent Lost Height Restoredg

Based on the mean height measurement of the closestmeasurement of the closest, unfractured vertebrae above and below the treated leveland below the treated level

A i idli d i Anterior, midline, and sometimes posterior measurements are taken

Page 31: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Example: Percent Lost Height Restoredp g

20 mm 24 mmAvg. 30 mm

% L t H i ht R t d% Lost Height Restored = (24 – 20) / (30 - 20) or 4/10 = 40%40%

Page 32: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Vertebral Body Height RestorationPercent of Lost Vertebral Body Height RestoredPercent of Lost Vertebral Body Height Restored

In a U.S. Multicenter, Prospective Single Arm Study– 65 patients treated – 30.2% of the average lost65 patients treated 30.2% of the average lost

midline height was restored for all fractures– Among reducible fx’s*, ( 78% of all fx’s), an g , ( ),

average of 58% of lost midline height was restored– Mean fracture age was 4.3 monthsg– No evidence of loss of improvement at two year

follow-up

Kyphon U.S. Study; Data on file at Kyphon Inc.

* “Reducible” refers to measurable fractures where at least 15% of predicted height was lost due to fracture.

Page 33: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Vertebral Body Height RestorationPercent of Lost Vertebral Body Height RestoredPercent of Lost Vertebral Body Height Restored

Lieberman et al (2001) states of 70 fractures treated, average lost midline height restored wastreated, average lost midline height restored was 35%– In the group of fx’s that were reducible g p

(70% of all fx’s treated), lost midline height restored was 47%*

– Mean fracture age was 5.9 months*A reducible fracture is defined by Lieberman as having restored at least 10% of lost vertebral body height at the midline with kyphoplasty.

Lieberman et al. (2001) Spine 26: 2, 1631-1638

Page 34: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Vertebral Body Height RestorationPercent of Lost Vertebral Body Height RestoredPercent of Lost Vertebral Body Height Restored

Theodorou et al (2002) reported that among 24 f l h i h d 52%fractures average lost height restored was 52%– Average lost anterior height restored was 52%– Average lost midline height restored was 66%– Mean fracture age was 3.2 months

Theodorou et al (2002) J Clin Imaging 26:1-5

Page 35: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Significant Pain Reduction

Following Balloon Kyphoplasty, Ledlie, et. al. (2003) Reports the mean pre-operative pain VAS score was 8.6 (96 cases). The post-operative mean VAS scores were 2.7 (89 cases) at 1 week and 1.4 (29) at 1 year follow up(29) at 1 year follow-up

I t ti l i G fi t l (2001) In a retrospective analysis, Garfin, et. al. (2001) reported “most patients have gone from narcotic analgesics to over the counter medication”analgesics to over the counter medication

1. Garfin SR (2001), 2. Ledlie J (2003)

Page 36: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Significant Pain Reductiong Multi-center prospective single-arm U.S. study

A f 60% d ti i i

1

– Average of 60% reduction in pain– Pre-operative VAS score = 7.5, one-week post-op follow-up VAS = 3 (p<0.01)– Results persisted for two years. (n=100)

Ledlie et al (2002) reported similar results pain reduction was noted at oneLedlie et al. (2002) reported similar results, pain reduction was noted at one week follow-up, with a continuation in improvement at one year 2

1. Kyphon U.S. Study, Data on file at Kyphon Inc. 2. Ledlie et al. (2003) J Neurosurg (Spine 1) 98: 36-42

Page 37: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Improvement in Quality of Life Coumans et al (2003) report on 78 patients and 188 procedures,

Patient quality of life is reflected by marked improvement in seven measures of SF-36 scores

Black bar= pre-opGray bar =post-op

Higher score indicates better performancePF= Physical Functioning, V= Vitality, RF=Role Functioning, SF= Social Functioning

Coumans et al. (2003) J Neurosurg (Spine 1) 99:44-50

BP= Bodily Pain, RE= Role Emotional, GH =General Health, MH=Mental Health

Page 38: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Activities of Daily LivingActivities of Daily Living Ambulatory Status

St di i di t th t b l t t t i i kl i d ft B ll–Studies indicate that ambulatory status is quickly improved after Balloon Kyphoplasty and persists at one year

–In a retrospective analysis following 79 patients treated (Ledlie et al), 80% f ll ti t f ll b l t t k f ll d 27 f th•80% of all patients fully ambulatory at one week follow-up and 27 of the

patients followed for one year maintained full ambulatory status •90% of patients (10 out of 12) who were wheelchair-bound preoperatively were ambulatory at one week follow-up

Ledlie et al. (2003) J Neurosurg (Spine 1) 98: 36-42

Page 39: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Improved Activities of Daily LivingF tiFunction

Coumans et al report 15% improvement in function as shown by O t Di bilit I d (ODI)Oswestry Disability Index (ODI)

• Measurements in the early post-operative period and continuing through long term follow-up (12-18 month f/u)

Coumans et al. (2003) J Neurosurg (Spine 1) 99:44-50

Page 40: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Improved Activities of Daily LivingF tiFunction

A multicenter prospective single arm U S study measured back function A multicenter, prospective single-arm U.S. study measured back function– Evaluated the ability to bend forward, lift 10 pounds and

stand for one hour both pre and post-operatively – Significant improvement was noted at one month and

persisted at two- year follow-up in all three areas

Kyphon U.S. Study, Data on file at Kyphon Inc.

Page 41: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Patient SatisfactionPatient Satisfaction

In a prospective U.S. study, patients were asked to rate their level of satisfaction with the outcome of their k h l t dkyphoplasty procedure – Scale of 1-20

• 1 = “completely dissatisfied”20 “ l t l ti fi d”• 20 = completely satisfied

The mean score at one week post-operative was 17.5 and persisted throughout two year follow-up (n=100 patients)

Kyphon U.S. Study, Data on file at Kyphon Inc.

Page 42: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Low Complication RateLow Complication Rate

In a literature review of 1342 vertebrae treated withIn a literature review of 1342 vertebrae treated with balloon kyphoplasty– Total adverse events are 1% per fracture (2% per patient)

Bone cement leaks associated with injury are < 0 2% per fracture– Bone cement leaks associated with injury are < 0.2% per fracture (<0.3% per patient)

Balloon kyphoplasty can compact cancellous bone and Balloon kyphoplasty can compact cancellous bone and create a cavity

The low complication rate is also related to the way in which viscous bone cement is delivered into the cavity under fine manual control

Page 43: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

ConclusionsConclusions

Kyphoplasty is a safe and effective treatment for osteoporotic compression fractures Safe and effective for pathological fractures p g Usually 1 night stay in hospital and can be

done as outpatientdone as outpatient

Page 44: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyCase StudyPatient: 61 YO FemaleDiagnosis: Multiple MyelomaFracture Reduced: T11-L2, 1 ½ yrs old

Courtesy of Kent Grewe, M.D., Portland, OR

Page 45: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyCase Study

Patient: 76 YO FemalePatient: 76 YO FemaleDiagnosis: Metastatic Lung CancerFracture Reduced: T8, 8 weeks old

Courtesy of Henry Small, M.D., Houston, TX

Page 46: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case Studyy

Patient: 80 YO FemaleDiagnosis: Primary OsteoporosisFracture Reduced: L1, 2 months old

Courtesy of James Hazel, M.D., Richland, WA

Page 47: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case Studyy

Patient: 65 YO FemaleDiagnosis: Primary OsteoporosisFracture Reduced: L2, 9 weeks old

C f Vi L idi M D Philli b NJCourtesy of Vito Loguidice, M.D., Phillipsberg, NJ

Page 48: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyCase StudyPatient: 61 YO MaleDiagnosis: Multiple MyelomaFracture Reduced: T11, 5 weeks old

C f P l P M D H TXCourtesy of Paul Pagano, M.D., Houston, TX

Page 49: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyCase StudyPatient: 79 YO FemaleDiagnosis: Primary osteoporosisFracture Reduced: T-11, 7 weeks old

f dCourtesy of James Hamada, M.D., Torrance, CA

Page 50: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyCase Study

Patient: 61 YO MalePatient: 61 YO MaleDiagnosis: Multiple MyelomaFracture Reduced: T-11, 5 weeks old

Courtesy of Donald Schomer, M.D., Houston, TX

Page 51: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyCase StudyPatient: 81 YO MaleDiagnosis: Primary osteoporosisFracture Reduced: L-1, 10 days old

f kCourtesy of Bruce Orisek, M.D., Santa Cruz, CA

Page 52: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Case StudyCase StudyPatient: 89 YO FemaleDiagnosis: Primary osteoporosisFracture Reduced: T-7, 1 year old Fx (2 Stage Inflation)

f d llCourtesy of Wade Wong, DO, La Jolla, CA

Page 53: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Literature Review ReferencesLiterature Review References

Boszczyk et al (2004) Microsurgical interlaminary vertebro and kyphoplastyBoszczyk et al. (2004) Microsurgical interlaminary vertebro- and kyphoplasty for severe osteoporotic fractures. J Neurosurg (Spine 1) 100:32-37

Coumans et al (2003) Kyphoplasty for vertebral compression fractures: 1-year clinical outcomes from a prospective study. J Neurosurg (Spine 1) 99:44-50

D dene et al (2002) K phoplast in the treatment of osteol tic ertebralDudeney et al. (2002) Kyphoplasty in the treatment of osteolytic vertebral compression fractures as a result of multiple myeloma. J Clin Oncol 20:2382-2387

Fourney et al. (2003) Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients J Neurosurg (Spine 1) 98:21-30vertebral body fractures in cancer patients. J Neurosurg (Spine 1) 98:21-30

Garfin SR, Yuan HA, Reiley MA (2001) Kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26:1511-1515

Komp et al (2004) Minimally invasive therapy for functionally unstableKomp et al. (2004) Minimally invasive therapy for functionally unstable osteoporotic vertebral fracture by means of kyphoplasty: Prospective comparative study of 19 surgically and 17 conservatively treated patients. J Miner Stoffwechs 11 (Suppl 1):13-15

Kyphon U.S. Multicenter Prospective Single Arm Study. Data on file atKyphon U.S. Multicenter Prospective Single Arm Study. Data on file at Kyphon Inc.

Lane et al. (2002) Minimally invasive options for the treatment of osteoporotic vertebral compression fractures. Orthop Clin N Am 33:431-438

Page 54: Osteoporotic Fractures - Pennsylvania Brain & Spine …pabrainspine.com/media/presentations/KYPHOPLASTY.pdf · Balloon KyphoplastyBalloon Kyphoplasty Surgical Approaches and Technique

Literature Review ReferencesLiterature Review ReferencesLedlie J, Renfroe M (2003) Balloon Kyphoplasty: One Year Outcomes in

Vertebral Body Height Restoration, Chronic Pain, and Activity Levels. J y g , , yNeurosurg (Spine 1) 98: 36-42

Lieberman et al (2001) Initial Outcome and Efficacy of Kyphoplasty in the Treatment of Osteoporotic VCFs. Spine 26: 2, 1631-1638

Lieberman IH, Reinhardt M-K (2003) Vertebroplasty and kyphoplasty for , ( ) p y yp p yosteolytic vertebral collapse. Clin Orthop 415(Suppl):S176-S186

Phillips et al. (2003) Early radiographic and clinical results of balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures. Spine 28, 19: 2260-2267

Phillips et al. (2002) An In Vivo Comparison of the Potential for Extravertebral Cement Leak After Vertebroplasty and Kyphoplasty. Spine 27, 19: 2173-2179

Theodorou DJ, Theodorou SJ, Duncan T, Garfin SR, Wong W (2002) Percutaneous Balloon Kyphoplasty for the Correction of Spinal Deformity in yp p y p yPainful Vertebral Compression Fractures. J Clin Imaging 26:1-5

Voggenreiter G, Sadik M, Majetschak M, et al. (2004) Treatment results of the kyphoplasty balloon technique. MedReview:17-18

Wilhelm K, Stoffel M, Ringel F, et al. (2003) Preliminary experience with balloon , , g , ( ) y pkyphoplasty for the treatment of painful osteoporotic compression fractures. Fortschr Rontgenstr 175:1690-1696

Wong W, Reiley MA, Garfin SR (2000) Vertebroplasty / Kyphoplasty. J Women’s Imaging 2(3)