Becker's Spine Review

15 Executive Briefing How 2 organizations tackle one of the biggest problems in healthcare, together: vertebral compression fractures T he under-diagnosis of and limited treatment options for patients with vertebral compression fractures (VCF) can contribute to poor outcomes among VCF patients, opioid reliance and added cost to the healthcare system. Vertebral compression fractures often occur among adults with osteoporosis and have been a significant public health threat for decades. In 1984, the National Institutes of Health led the Consensus Development Conference on Osteoporosis to examine the condition and scientific evidence around treatment. Out of that conference, the National Osteoporosis Foundation (NOF) was formed with the mission of making a positive impact on patients with osteoporosis. "Historically, if a patient with osteoporosis had a vertebral compression fracture, they were recommended bed rest, taking medications and limiting activity," said Joshua Hirsch, MD, Vice Chair of Interventional Care in the Quality and Safety Service Line; Chief of Interventional Radiology; Division Chief of Neurointerventional Radiology; and Chief of the Interventional Spine Service at Boston-based Massachusetts General Hospital. "Theoretically, physicians told patients, they would get better over time with conservative therapy. If they did, great; if not, they had limited alternatives." Medical technology companies, including Medtronic, realized there was a significant need for innovation in VCF treatment to relieve the patients' pain and return them to normal activity. The same year NOF was formed, surgeons performed the first-ever vertebroplasty in France. In the 1990s, the procedure was introduced to the U.S. at Charlottesville-based University of Virginia and since then has become a viable treatment option across the country. "Putting someone on bed rest, limiting their activities and putting them on medication isn't good for the rest of their body," said Dr. Hirsch. "In my practice, we ofter saw near immediate results with vertebroplasty; there were people who had been hospitalized for an extended period that received the treatment and they would go home the next day. It was one of the most stunning things myself and many other physicians had seen in their practices." Medtronic then developed balloon kyphoplasty, a minimally invasive procedure that reduces and stabilizes VCF related to osteoporosis, cancer or benign lesions. Since the initial technology launched, Medtronic has developed better balloons, an improved cement delivery system and added access tools to reduce radiation exposure. Over the years, studies comparing balloon kyphoplasty to non-surgical management have shown balloon kyphoplasty produced better pain relief and quality of life for patients with acute VCF compared to non-surgical management. 1,2,3,4 Dr. Hirsch notes that "Balloon Kyphoplasty was a critical next step in the evolution of augmentation procedures." For example, one study showed that one week after receiving balloon kyphoplasty, 46 percent of patients reported pain reduction, compared to 15 percent of non-surgical management patients; at one month and two years after treatment, the balloon kyphoplasty patients continued to report significantly better pain relief than non-surgical management. 1 Clinical evidence also has shown fewer balloon kyphoplasty patients used pain medications at 12 months and opioids at six months when compared with non-surgical management. 1 Additional findings in peer-reviewed clinical studies include, compared to non-surgical management: • One month after treatment, balloon kyphoplasty patients reported four times greater quality of life improvement than non-surgical management, and balloon kyphoplasty patients continued to maintain significant quality of life improvement two years post treatment 1 • Balloon kyphoplasty patients had higher patient satisfaction two years after treatment 1 The complication rate with Kyphon Balloon Kyphoplasty has been demonstrated to be low. There are risks associated with the procedure (e.g., cement extravasation), including serious complications, and through rare, some of which may be fatal. Joshua Hirsch, MD Vice Chair, Interventional Radiology Division Chief, Interventional Neuroradiology & Chief Interventional Spine Service Massachusetts General Hospital Sponsored by:

• Cover