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New procedure relieves back pain from collapsed vertebra Many patients suffering with excruciating back pain from spinal fractures can find nearly immediate relief with a recently developed balloon procedure that reinforces collapsed bone with an acrylic replacement.  “It’s a new thing,” said neurosurgeon Sunil Patel, M.D., associate professor and interim chair, Department of Neurological Surgery. “It came from managing patients with osteoporosis. Their bones are weakened, and they get a lot of collapse of their spinal bones.” Some of his patients have suffered bone loss from radiation treatments for leukemia.  He said that until now there really was no good treatment for it. Pain killers and back braces were about all his toolbox held until the procedure, called balloon kyphoplasty, was developed.  While the patient is under general anesthesia, the neurosurgeon or specially trained orthopaedic surgeon inserts a needle through the skin and into the collapsed bone. Through the needle, the surgeon introduces a balloon that expands the vertebra. He then fills the void with a liquid acrylic that hardens permanently. Patel calls it a potentially risky procedure, mainly because it means working in such close proximity to the spinal cord. “The worst thing that could happen is that the acrylic could spill into the spinal canal.” For that reason, he said, the surgeon relies on two-dimensional fluoroscopy to guide the needle to the precise spot to deliver the balloon and liquid acrylic. “The spine is a three-dimensional object, and the spinal cord is right up against it,” Patel said. “We have to be prepared as surgeons, if the acrylic did pour out, to open the whole thing and take the acrylic out of the wrong spot.” For that reason, the procedure has to be performed by a surgeon experienced in surgery of the spine, and the patient has to meet selection criteria. “Pain is the presenting symptom,” he said. “The procedure treats a disability, and that disability is pain that comes from instability of the spine.” He said women who have gradual bone loss from osteoporosis often compensate with strengthened muscles to maintain stability. “With gradual strengthening of their muscles and ligaments, they are able to continue as they have been doing. If they are walking around, I’ll leave this alone.” The procedure is not done for cosmetic reasons. “We’re not trying to align their posture,” Patel said, although, it does improve posture. Patients who have had kyphoplasty have to be careful not to overdo physically, he added. Their freedom from pain can lead them to forget they have bone loss throughout their body. Too much physical exertion could lead to further injury.  “I’ve occasionally treated patients with horrible back pain, and they have some cardiac disease that didn’t show up because they were put up in bed. After fixing a patient’s back pain, I got a call from a cardiologist saying he has admitted the patient I operated on the month before,” Patel said.  “He was out running around and got angina. It probably wouldn’t have happened if I hadn’t fixed his back. It’s amazing how you can unearth certain illnesses because they increase their activities.”   Friday, Oct. 15, 2004 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.