Our Dad is in the hospital with two nasty vertebral compression fractures. He has very brittle bones from osteoporosis. They are trying to decide whether or not to do a balloon kyphoplasty. We are wondering if it makes any sense to do this when all the other bones are weak, too. Treating one level won't stop the problem from occurring in the other bones, will it?
This is a good question that deserves an answer. Osteoporosis (decreased bone density) that affects all the bones should be addressed with treatment (usually medication and specific exercises). But the immediate problem must be dealt with first -- to provide pain relief if nothing else.
Patients with painful vertebral compression fractures tend to give in to their pain. They find that a stooped, flexed forward posture helps take pressure off the spinal nerves and is more comfortable than standing up straight. Unfortunately, the stooped posture accompanied by spinal kyphosis (forward curvature of the spine) can lead to spinal deformity and more pressure on the bones.
Restoring vertebral height with the balloon kyphoplasty procedure addresses the fracture-related pain and the kyphotic deformity. As you suspect, it doesn't always mean prevention of other fractures from developing. In fact, cement leakage and increased rigidity from the procedure are two problems surgeons are still trying to address in an effort to reduce new fractures.
The bottom line is that vertebral compression fractures from osteoporosis cause disabling pain and deformity. These two factors together negatively affect a person's physical function and ultimately reduce quality of life. Stop-gap measures like balloon kyphoplasty are offered to patients who do not respond well to conservative care and who therefore end up with persistent pain. Balloon kyphoplasty isn't always accompanied by complications and it can be a very successful treatment technique.
One thing you can do as a family for your father is to support him through this rough spot. Make sure he receives adequate treatment for the underlying osteoporosis that is affecting the other bones. Follow-up is important -- and with osteoporosis, follow-up is for the rest of his life, not just until the immediate crisis is over.
His primary care physician will be able to direct and guide you as to what is needed whether that is medication, an exercise program, or other avenues of treatment. A physical therapist can get him set up on a home program for the exercise program specific to osteoporosis, monitor his strength, and aid in improving posture. There is much that can be done for osteoporosis to prevent future problems from developing.
Panagiotis Korovessis, MD, PhD, et al. Balloon Kyphoplasty Versus KIVA Vertebral Augmentation -- Comparison of 2 Techniques for Osteoporotic Vertebral Body Fractures. In Spine. February 15, 2013. Vol. 38. No. 4. Pp. 292-299.
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