Procedure Ends Compression Fracture Pain

Outpatient, minimally invasive kyphoplasty brings immediate back relief.

It wasn’t long after Alice* moved to Interlachen a few years ago that a sign she passes on her way to the grocery store began calling out to her. Being the animal lover that she is, it was inevitable that Alice would eventually answer that call.

“The sign is for SAFE, which is an acronym for Saving Animals from Euthanasia,” says Alice, 72. “It was put up by a nearby animal shelter, and since I love animals, I thought there might be something I could do to help out. Now, I volunteer there twice a week.

“I mostly clean the kitty cat room, which is fine because I have two older male cats myself. I also have two beautiful German shepherds, and I’m fostering two kittens that I’ve had since they were a day and a half old.”

A retired information systems manager, Alice is an active sort who seldom spends time on the couch watching TV. That recently became her plight, however, after she experienced a disabling back injury.

To the best of her knowledge, Alice was injured a little more than a year ago while walking her dogs. When two stray dogs began to follow, Alice’s dogs shifted into protection mode.

“I could hear the growls from the other dogs getting closer as they came up behind us,” Alice says. “All of a sudden, my two dogs stopped and stood in front of me. When I turned around, my one dog jumped up and body-slammed me to the ground.

“After that, both of my dogs just stood over me as if to protect me, and the other dogs went away. I really appreciate my dogs being so protective, but I knew that being knocked down by a 125-pound German shepherd would probably cause some damage, and it did.”

Based on the pain she felt at impact, Alice first thought that the damage was a broken hip. Nevertheless, she was able to get to her feet and finish her walk, but the pain in her back soon began to intensify. Then it became debilitating.

“I could still walk, but my back hurt so much that I had to walk all bent over like an old lady, which irritated me,” Alice says. “Pretty soon, sleeping became a problem, too, because I couldn’t get comfortable lying on my back or side.

“It was hard working at the animal shelter because I was in excruciating pain all the time. I couldn’t do a lot of the things I like to do, including gardening and other outside chores. I knew I had to get some help.”

“Dr. Hanes is an excellent doctor whom I trust completely.” – Alice

Alice sought that help from the staff at Jax Spine & Pain Centers, a practice that specializes in the use of progressive interventional treatment options to address chronic joint, neck and back pain.

Alice was already familiar with the practice.

“I’ve been visiting Jax Spine & Pain Centers once or twice a year since 2014,” she details. “I hurt my back in a boating accident back then, and ever since I’ve been going there and getting steroid injections to relieve the pain.”

When the pain from her fall persisted, Alice returned to Jax Pain & Spine Centers thinking she would probably get another steroid injection. However, an MRI revealed that addressing the damage would require more.

“When we got the MRI back it showed that Alice had what we commonly refer to as either a spinal, or vertebral, compression fracture,” reports Michael Hanes, MD, of Jax Spine & Pain Centers.

A spinal compression fracture occurs when a vertebra weakens and either breaks or collapses to where it affects the nerves in the back. That can cause severe pain as well as deformity and a stooped posture if left untreated.

Compression fractures can occur anywhere in the spine, but the break or collapse most often affects the lower portion of the thoracic, or middle, area.

As it was with Alice, a compression fracture can be caused by a bad fall or some other form of trauma. Compression fractures typically are traced to osteoporosis, especially in older people.

Osteoporosis and its precursor, osteopenia, are conditions in which bone growth fails to keep pace with natural bone degeneration until bone mineral density becomes dangerously low.

According to federal data, about 54 million Americans, most of them postmenopausal women, suffer from osteopenia, osteoporosis or low bone mass, all of which can greatly weaken and ultimately fracture bones in the spine.

Indeed, in people with osteoporosis, a compression fracture can be produced by something as simple as a cough or from lifting a heavy object. Many people don’t know they even have the disease until a fracture occurs.

Painless Procedure

Compression fractures can be repaired through a painless, minimally invasive, injection-like procedure called kyphoplasty (pronounced ki-fo-plas-tee). The outpatient treatment takes about 30 minutes and is completed under light sedation at Jax Spine & Pain Centers. It can be performed within 24 hours of a patient being diagnosed with a spinal fracture.

“Prior to the development of this procedure, patients with a spinal compression fracture would usually be placed in a brace before being sent home in the hope that the fracture would heal on its own,” says Kassai Silva, MD, at Jax Spine & Pain Centers.

“The brace was very uncomfortable, and the patients sometimes had a hard time breathing and ambulating. As a result, it wasn’t unusual for some patients to wind up in the hospital with pneumonia or blood clots that could go to their lungs.

“That’s why kyphoplasty is considered by many to be a lifesaver. It repairs the fracture and prevents patients from suffering some of these other issues, so it actually reduces the risk of mortality in patients with a compression fracture.”

A study of more than 2 million compression fracture patients showed that those undergoing kyphoplasty were 22 percent less likely to die from complications associated with the fracture than those who did not receive the procedure.

“That’s one of the reasons that we, as doctors, find this procedure so fulfilling,” adds David Salek, MD, of Jax Spine & Pain Centers. “We appreciate the fact that not only does it have an almost immediate effect on the patients’ pain, but it can also save their life.”

Patients with compression fractures are often in so much pain that they don’t get out of bed or a chair, and because they’re sitting so much more than usual, blood begins to pool in the legs. That can develop into venous stasis, which can lead to a clot.

“That clot can either sit in the leg or it can travel up to the lung, which can be quite dangerous. So, another reason this procedure helps reduce mortality rates is because the vertebral bodies themselves are an important structure in respiration,” Dr. Salek says.

“Your rib segments move as you take in a deep breath, and as those rib segments move, the spine moves. If patients are feeling pain from a compression fracture, they typically aren’t breathing as deeply. As a result of the patient not breathing deeply, the lung sticks to itself, and that can lead to bacteria or a viral kind of seeding within the lung. That, of course, can lead to pneumonia.

Immediate Results

Kyphoplasty is performed through a small incision in the back through which the physician uses a needle and x-ray guidance to insert a balloon into the fractured vertebra. By inflating the balloon, the compressed vertebra returns to its original height.

The cavity created by the expansion of the balloon is filled with a fast-drying cement that immediately stabilizes the fracture, alleviating pressure on the nerves and eliminating the pain.

“Another great thing is that it’s a permanent fix,” adds Dr. Hanes. “It prevents the vertebra that has collapsed or fractured from ever fracturing again or losing more height, which is a critical aspect.

“When you see a man or woman in their 80s who’s all hunched over, it’s usually because they suffered a lot of spinal compression fractures that were never treated. This procedure can correct that problem, and it corrects it for good.”

An additional benefit of having the treatment at Jax Spine & Pain Centers is that it is less costly.

“If you go to a hospital or surgery center, you’ll pay significantly more because you also need to pay professional and facility fees,” says Mike Bergantino, chief operating officer of Jax Spine & Pain Centers. “At our office, your regular office co-pay covers the cost.”

The results are immediate, which allows patients to quickly return home and to regular activities.

“The cement that we place in the cavity is dry before the patient leaves our office,” Dr. Silva notes. “So, the only reason we don’t say, Go home and do everything you normally would, is because the patient received sedation.

“That’s why we tell our patients, Go home and be careful for 24 hours. After that, they’re usually good to go. Even if the patient is 80 years old and walks two miles a day, he or she can go back to walking those two miles within 24 hours.

“That’s another aspect of this procedure. Patients typically go home, take some acetaminophen, and by the following day, they feel great. In fact, a patient that I did a kyphoplasty on emailed the next day saying she felt 100 percent pain relief.”

Dr. Salek received a similar response from a patient who had several spinal compression fractures. After performing kyphoplasty on three of the fractures, the pain was almost completely alleviated, the doctor reports.

“That patient actually had seven levels that were fractured, so we started by treating three,” Dr. Salek details. “In some cases, we do have to go back and repair the rest. But in this case, the patient had nearly 100 percent relief after just a few days.

“Now we’re waiting and watching to see if we’ll need to treat any additional levels. That’s how effective this procedure can be. And because we do it in our office, it’s an effective treatment for patients who are not candidates for surgery in a hospital space.”

“Miracle Worker”

When recommending kyphoplasty, the doctors at Jax Spine & Pain Centers usually encourage patients, especially older patients, to have the procedure done as soon as possible. Waiting can result in further damage.

Alice weighed those variables and others in making her decision to undergo kyphoplasty. She is now among those who have greatly benefitted from the treatment, which has allowed her to resume an active lifestyle.

“The procedure was absolutely painless, the relief was immediate, and now I’m walking, gardening and doing all the things I like to do outside again,” she enthuses. “I can even do housework and laundry again because the pain I was experiencing is gone.

“For me, this treatment has been a life-changer. That’s why I only have wonderful things to say about Dr. Hanes and his staff. They’re all caring and professional.

Dr. Hanes really listens to his patients, and I love that he is so meticulous.

“I’m so glad he recommended this treatment for me. Like I said, Dr. Hanes is an excellent doctor whom I trust completely, and I recommend him to anyone because he’s a miracle worker.”

© FHCN article by Roy Cummings. mkb
*Patient’s name changed at her request.
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    • Jax Spine & Pain Centers

      Jax Spine & Pain Centers is one of north Florida’s leading providers in progressive interventional pain relief for the treatment of back, neck, shoulder, knee, hip and chronic pain. Their team of board-certified physicians and ... Read More

    • Michael Hanes, MD

      Michael Hanes, MD, is a board-certified anesthesiologist and interventional pain medicine specialist. He earned his bachelor’s degree from the University of Michigan and his medical degree from Michigan State University. Dr. Hanes completed an ... Read More

    • David Salek, MD

      David Salek, MD, is a double board-certified anesthesiologist and interventional pain management physician specializing in nonoperative orthopedic and spine injuries, minimally invasive procedures for back pain, neuromodulation and ky... Read More

    • Kassia Silva, MD

      Kassia Silva, MD, specializes in anesthesiology and pain medicine. She earned her bachelor’s degree from Florida Atlantic University in 2012 and her medical degree from the San Juan Bautista School of Medicine in Caguas, Puerto Rico, in 2016... Read More