Osteoporosis causes over 700,000 spinal fractures in the United States each year. Vertebral compression fractures (VCF) can result in kyphosis or dowager's hump, a debilitating condition characterized by chronic pain and increased mortality risk. Now, some Birmingham surgeons are getting results in the repair of VCFs using an innovative procedure called balloon kyphoplasty. "This is so much better and safer than our previous treatment options," says Dan Michael, MD. In years past, physicians relied on bracing, combined with pain medication. There were several drawbacks. The narcotics could be addictive and hard for elderly patients to tolerate. And, says Michael, who practices orthopedics at St. Vincent's, "we couldn't reduce the fractures with bracing. People stayed bent over. The only way to restore height was with major surgery. We'd have to put a rod in there and pry it open, which most people didn't want." In the early 1990s, researchers developed a minimally invasive procedure called vertibroplasty, where cement was squirted into the fracture to strengthen the bone. Unfortunately, surgeons were still unable to restore height with this method. To make matters worse, there were potential complications with cement leakage. The development of balloon kyphoplasty appears to have solved these problems. With this minimally invasive procedure, surgeons insert a hollow cannula into the fractured bone, through which an orthopedic balloon is guided into the fracture. The balloon is inflated, raising the collapsed vertebra. Once the vertebra is in the correct position, the balloon is deflated and removed, creating a cavity in the vertebral body. Surgeons fill the cavity with a cement that builds up the vertebra and holds it in place. The procedure usually takes under an hour and can be done with local anesthesia. Kyphoplasty has a low complication rate. "Leakage was a common problem with vertibroplasties," Michael says. "Whereas with kyphoplasty, because you have the cavity and you're putting cement in with light pressure, the leakage rate is very low." Probably more exciting is the fact the kyphoplasty actually restores vertebral body height and spinal alignment. This is significant because the stooped spine causes compression of many vital organs, making it more difficult to breathe, walk, or eat properly. Some studies have shown that a high percentage of patients complaining of chest pains who didn't have heart problems had compression fractures. Kyphosis sufferers have an estimated 24% increase in mortality compared to patients without VCFs. While the majority of kyphoplasty procedures are for osteoporosis related VCFs, surgeons are finding more uses for the treatment. Patrick Pritchard, MD, a neurosurgeon at UAB, has used kyphoplasty with trauma patients. "A lot of times," Pritchard says, "trauma patients with spinal fractures may have other injuries that prohibit them from undergoing a long operation. They may need a quick, non-invasive procedure that doesn't involve much blood loss." In these cases, surgeons might combine kyphoplasty with the standard open surgical procedure. In the case of younger trauma patients, Michael explains that, "because their bone is denser, it's more difficult to move. You've got to get to them pretty soon or it won't work. With one patient in her mid-thirties, I popped two balloons before I was able to get her back up." Pritchard has found kyphoplasty useful for some cancer patients. "For example," he says, "take someone with breast cancer which spreads to the spine, where there is collapse of the bone. The patient may have horrible pain. Although they may only have months to live, we can try to make that time as enjoyable as possible." Pritchard would like to see more randomized studies of kyphoplasty. "There's a big push for evidence based medicine," he says. Class one, which is a prospective, randomized controlled trial, is considered the highest level of evidence. "The problem," Pritchard says, "is that nobody wants to be randomized. They all want the kyphoplasty treatment." Nonetheless, Pritchard believes more good studies will be done. In fact, UAB has been invited to participate in a study comparing kyphoplasty with vertibroplasty. As to the future, Pritchard says that the Europeans are experimenting with different filler substances. "Instead of putting a piece of acrylic cement in that's going to stay acrylic cement forever," he says, "they're using a calcium that's extended with growth factors that may turn over into bone."