Becker's Spine Review

17 Executive Briefing Sponsored by: P atients suffer vertebral compression fractures when their bones become too fragile. VCF complications may include impaired gait, disability, reduced lung function, early satiety, future fracture risk and mortality. The National Osteoporosis Foundation reports a vertebral fracture occurs every 22 seconds globally, and about two-thirds of VCFs are initially asymptomatic and under-diagnosed. 1 Older women, especially, are at great risk of developing VCFs. A 2015, 12-year study published in Mayo Clinic Proceedings compared hospitalizations for osteoporotic fractures in women 55 years and older to hospitalizations for other conditions. The study discovered 4.9 million hospitalizations for osteoporotic fractures in women, more than the hospitalizations for myocardial infarction, stroke or breast cancer. 2 Patients with VCFs have a variety of treatment options, including non-surgical management (NSM), balloon kyphoplasty (BKP) and vertebroplasty. NSM often involves bracing patients and prescribing opioids for pain management. NSM in the elderly population poses a particularly challenging healing environment, "because if you give them enough time, they will form fibrosis in the fracture, but if their bone quality is that bad, they have no innate ability to heal themselves," says Brett Schlifka, DO, a neurosurgeon in Wellington, Fla. "I never brace anybody because [it can be] such a worthless endeavor." And adding narcotics into the mix presents a "recipe for disaster" for the elderly, as the medication will make them "loopy" and at risk of losing their balance, says Dr. Schlifka. Drug reliance can be a problem Opioids play a major role in NSM of VCFs, so many providers seek alternative treatment methods to combat the opioid epidemic sweeping the nation. In 2015, the amount of opioids prescribed tripled the amount prescribed in 1999, according to the CDC. 3 The CDC reported 22,000-plus deaths related to prescription opioids in the United States in 2015, translating to about 62 deaths daily. 4 Consuming opioids for extended periods of time or in greater doses will increase risk of addiction, overdose or death. This nationwide epidemic is especially active in rural areas. Radiologist David Buechner, MD, of Memphis Radiological in Germantown, Tenn., notes the opioid epidemic is very present in his practice, and opioid-addicted patients have a higher morbidity rate, which leads to an excess of hospital admissions. Tennessee lawmakers are now taking action, pioneering a legislative commission in January 2018 dedicated to opioid issues. "Just having strict legislation to try to reduce the amount of prescriptions is only part of the answer," Dr. Buechner argues. "The problem is so complex; we have to offer alternative forms of therapy to patients." And it is imperative these alternative treatment options catch the condition early. The addictive potential of opioids poses a critical reason for the importance of early detection of VCFs. Dr. Schlifka agrees: "There are many benefits to treating early. We need a quick procedure with low morbidity and low risk that yields a high benefit of getting people out of the hospital, mobilized and off their narcotics quicker." That's where procedure-based pain management techniques, such as balloon kyphoplasty, come in. How balloon kyphoplasty stacks up against non-surgical management Balloon kyphoplasty is an augmentation procedure designed to stabilize the spine. Balloon kyphoplasty is a minimally invasive procedure for the treatment of pathological fractures of the vertebral body due to osteoporosis, cancer or benign lesion. Cancer includes multiple myeloma and metastatic lesions, including those arising from breast or lung, or lymphoma. Benign lesions include hemangioma and giant cell tumor. Surgeons mechanically treat a fracture by inserting and inflating a balloon to create an open cavity inside the bone for injecting bone cement. Surgeons insert a controlled amount of Kyphon bone cement into the cavity, which creates an internal cast to stabilize the fracture. "In my practice, the reason we want to do more balloon kyphoplasty is because evidence shows [patients] have much better pain relief short- and long-term and rewduce the amount of opioid use," explains Dr. Buechner. "Pain is the number one reason people seek medical care, so we need a viable procedure- based option to treat pain." Medtronic's BKP offering is Kyphon Balloon Kyphoplasty, a minimally invasive procedure designed to repair spinal fractures. More than 15,000 physicians have undergone balloon kyphoplasty training worldwide and treated more than 1 million fractures with the procedure. Medtronic has conducted five multicenter trials on VCFs in patients with osteoporosis and cancer, and has the largest randomized controlled trial on BKP versus NSM. "We have certainly observed pain relief profiles across these studies, finding statistically and clinically significant pain reductions from baseline observed early from week one that persisted through 12 months or 24 months," says John Tillman, PhD, clinical director at Medtronic. Curbing Opioid Use for Vertebral Compression Fractures With Balloon Kyphoplasty

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