Inflation Elation

Balloon procedure alleviates agony of spinal compression fracture.

Leslie Bakkilia

Since her procedure, Leslie can stand and cook for hours without back pain.

Leslie Bakkila prepared for her teaching career by earning dual master’s degrees in reading and curriculum development. Using her education as a foundation, she taught elementary school, primarily second and fourth grade, for 40 enjoyable years.

A Maryland native, Leslie did most of her teaching in the Midwest and West.

“My husband was a Navy pilot who attended the Naval Academy in my hometown of Annapolis,” shares Leslie, 71. “His work took us to Ohio for 15 years, then we got transferred to Redondo Beach, California, where we lived for 23 years.”

Being a teacher was the perfect profession for a military wife who relocated across the country. She earned various jobs by starting out as a substitute at a school, which eventually hired her for a full-time position.

“I absolutely loved the children. I connected with them and understood what they needed,” Leslie relates. “I recognized when the students were tired of listening and manipulated the curriculum a little to better meet their needs.

“It’s important to catch any difficulties the children may have while they’re in second grade so they don’t get to fourth grade with reading problems. I was lucky to work in very progressive schools that liked my approach to teaching.”

Two years ago, Leslie and her husband retired and relocated to the Del Webb® adult community in the seaside town of Ponte Vedra. Leslie enjoys swimming at the community pool and exploring St. Johns County by car. But she was unable to do either activity after injuring her back this past summer.

“On July 4 about 8:30 at night, I was taking a shower when I slipped and fell flat on my back like a wet seal,” Leslie recalls. “The pain was awful. I had to crawl out of the shower to call for my husband. We called an ambulance, which came right away and took me to the hospital.”

Tests at the hospital revealed that Leslie suffered a compression fracture in one of the vertebrae in her lower back. With a compression fracture, the endplate of the affected vertebra is compromised and collapses. The compression causes a loss of bone integrity and a corresponding loss of height within the vertebra.

Compression fractures sometimes heal on their own. The emergency room physician told Leslie that would likely be the case with her and sent her home. Except the fracture didn’t heal.

“By August, I knew something wasn’t right because I was still in a lot of pain,” Leslie laments. “It was horrible, a 10 on a scale of one to 10. It was like my back had a crease in it, and every time I moved, I felt pain.”

Leslie sought further help from her primary care provider, but attempts to alleviate her pain using medication, bracing and physical therapy failed. As a result, Leslie’s primary care physician referred her to Kai McGreevy, MD.

A board-certified neurologist, pain management specialist and founder of McGreevy NeuroHealth, Dr. McGreevy uses the most advanced treatment modalities to restore his patients’ neurological deficits and ease their pain.

“Ms. Bakkila came to me eight weeks after suffering a vertebral compression fracture,” Dr. McGreevy recalls. “These fractures can be extremely painful because the area around the vertebrae is rich with nerve fibers.

“She was experiencing severe midline back pain at the site of the fracture that was greatly impacting her quality of life. She couldn’t drive a car or swim, which she likes to do, and her pain was preventing her from finding a comfortable sleeping position, which is common, and further fueled her discomfort.”

Restore Height, Relieve Pain

A CT scan revealed that Leslie’s compression fracture resulted in a loss of vertebral height of approximately 30 percent and was the root cause of her intense pain. To correct the problem, Dr. McGreevy recommended performing a balloon kyphoplasty, which Leslie agreed to move forward with.

“For years, the standard of care for compression fractures was to immobilize the spine with a brace, have the patient rest for a period of time and, if the patient is making progress, begin gradual physical therapy,”
Dr. McGreevy educates.

“Today, the more conventional wisdom suggests treating these fractures fairly aggressively. By performing the minimally invasive balloon kyphoplasty we can restore bone height and relieve the patient’s pain almost immediately.”

After reviewing Leslie’s CT scan, Dr. McGreevy determined there was no spinal cord involvement and no immediate threat to her spinal cord or spinal nerves.

“Those situations are contraindications for balloon kyphoplasty,” he says.

Balloon kyphoplasty is an interventional procedure that allows physicians to access the fractured vertebra using fluoroscopic guidance. It is performed by inserting a thin tube, called a cannula, through a needle inserted into the back.

“Once we access the fracture site, we inject a medical grade cement-like material into the vertebra to stabilize it,” Dr. McGreevy explains. “However, before we inject the cement, we must restore the vertebral body height. To do that, a special balloon is placed through the cannula into the compressed vertebra and inflated, creating space for the cement to fill. When done, the cemented vertebra is stronger than native bone.

“The procedure, which takes 15 to 30 minutes to complete, is performed under conscious or twilight sedation, so there is no general anesthesia. Recovery is typically very quick. Often, patients feel relief from their pain while they are in the post-anesthesia care unit (PACU) or within a few days of the procedure.”

Unique Expertise

Dr. McGreevy has earned certification in neuroimaging from the United Council for Neurologic Subspecialties (UCNS) and is uniquely qualified to diagnose and treat vertebral compression fractures and other painful disorders.

Neurologists with this certification are qualified to interpret advanced imaging, such as CT, MRI and PET scans. This task requires a high level of detailed knowledge of anatomy, pathology and complex imaging characteristics to identify normal from abnormal that is well beyond that attained in most neurology training programs.

“The benefit of a neurologist reading images in this instance is that the same physician knows what to look for based on the patient’s history and physical exam,” Dr. McGreevy maintains. “There is a great need for interventional pain physicians to learn how to read their own images since several brand new minimally invasive spine interventions are emerging, and there are important safety considerations and patient selection criteria that rely on imaging details.

“Being able to interpret imaging helped quickly identify suitability, safety and planning for Ms. Bakkila’s balloon kyphoplasty.”

The training and education required for certification makes the neuroimager a better neurologist and interventional pain physician.

Feat of Coordination

Dr. McGreevy’s diligent staff was able to get Leslie on the schedule at the surgery center, where balloon kyphoplasty is performed, within three days of the initial evaluation. That is quite a feat considering the immense amount of coordination involved in scheduling a procedure. Leslie greatly appreciated the effort.

“I first visited Dr. McGreevy on a Friday and had the procedure done the following Monday,”’ Leslie confirms. “That’s how quickly he treated me. And I’ll never forget that. I had to visit my cardiologist first because I had a heart problem, and
Dr. McGreevy arranged for that right away, too. I’m very grateful to him for doing that.”

According to Dr. McGreevy, Leslie reported significant pain relief shortly after the procedure.

“Within 24 hours, Ms. Bakkila was feeling 80 percent better,” the doctor discloses. “When I saw her in the clinic 10 days later, she was experiencing virtually no pain. At her two-month follow-up appointment, she was still reporting minimal pain.”
“My Pain Is Nothing”

Leslie confirms Dr. McGreevy’s report.

“My kyphoplasty procedure was performed on August 23 at noon, and afterward I felt pain relief within a half-hour,” she enthuses. “My pain had decreased to about a four out of 10, and I gradually got better and better. Now, my pain is nothing; most days it’s a one or two. If I overdo an activity, I just take a muscle relaxer or Tylenol® and that helps.”

Since undergoing the procedure, Leslie’s quality of life has improved as well.

“Our family recently visited, and I stood and cooked for three hours,” Leslie relates. “I’m also able to go shopping from 9 in the morning until 3 in the afternoon, and I’m pretty happy about that. I’m still not driving yet, but I can walk, swim and do
water aerobics.”

Leslie was nervous when she first arrived at McGreevy NeuroHealth, but  Dr. McGreevy’s calming manner quickly put her at ease.

“I liked Dr. McGreevy from the moment I met him,” she says. “He is very knowledgeable and compassionate. He knew exactly what he had to do, and he’s done the procedure many times, so I trusted him. On the day of surgery, he was right on time, and everything turned out very well.”

© FHCN article by Patti DiPanfilo. Photo by Jordan Pysz. js
Print This Article