January 22, 2003
FOR IMMEDIATE RELEASE

CONTACT: Tom Rosenberger, APR, Communications Department (513) 569-5260
CONTACT: Cindy Starr, MSJ, Communications Department (513) 584-2214

CINCINNATI -- Two important technologies are helping surgeons at the Mayfield Clinic & Spine Institute reduce disability in patients suffering from one of the most painful consequences of osteoporosis: a fractured or collapsed vertebra. The procedures, known as kyphoplasty and vertebroplasty, involve the structural repair of fractured vertebrae, which cause debilitating pain and disability in older adults.

Many patients become virtually pain-free after undergoing vertebroplasty or kyphoplasty, according to Andrew J. Ringer, M.D., a neurosurgeon with the Mayfield Clinic & Spine Institute and The Neuroscience Institute at The University Hospital. Ringer and a few of his Mayfield colleagues perform the procedures at The University Hospital and Good Samaritan Hospital.

About 700,000 vertebral fractures occur each year in the United States, 85 percent of them caused by osteoporosis.

Both vertebroplasty, which has been performed in the United States since the mid-1990s, and the newer kyphoplasty are minimally invasive, x-ray-guided procedures in which a physician passes a needle through the skin and injects a special bone cement into a fractured vertebral body. Kyphoplasty differs slightly in that, after inserting the needle, the physician drills a small channel, puts a very strong balloon inside and inflates that balloon. The balloon compacts the bone around it and in some cases even elevates the bone. The physician then deflates the balloon, removes it and fills the void with cement. The cement, called Methylmethacrylate, adds structural integrity to the bone and prevents further collapse and the pain associated with that collapse.

These procedures can be a godsend for patients whose osteoporosis has precipitated one or more vertebral fractures or collapse. Such patients, who range in age from 50 up to even 90, typically endure severe back pain when they are standing upright or carrying something.

"For a long time we have told these patients there was little we could do for them," says Dr. Ringer. "The traditional treatment was to put them to bed, put them in a brace, and give them calcium and other medications to help the body incorporate the calcium into the bone. We still give the medication and the calcium, but we now realize that confining elderly patients to bed rest can lead to muscle atrophy, thrombosis, pneumonia and other infections. In addition, a patient's bones actually soften further during bed rest in the absence of weight-bearing activity. Kyphoplasty and vertebroplasty clearly offer a preferable alternative."

There has been considerable debate in the medical community about which of the two procedures is superior, but at present no scientific evidence exists to show that one is necessarily better than the other, Dr. Ringer says. "Nevertheless, I have a conceptual feeling that if you have the opportunity to restore height, kyphoplasty is the preferred alternative. I have performed more than two dozen of these vertebral procedures during the last year, and at this point I tend to favor kyphoplasty."

If a patient's fracture is more than six months old, however, the balloon used in kyphoplasty does not inflate very well. So with older fractures surgeons typically use vertebroplasty.

About 85 to 90 percent of patients feel considerably better after undergoing kyphoplasty or vertebroplasty, and many are able to stop taking pain medications shortly afterward. Nationwide, the complication rate is about 2 percent. Complications reported to the FDA include soft-tissue damage and nerve root pain and compression, have been related to the leakage of bone cement. These complications can be avoided, Dr. Ringer said, by adding a barium powder to darken the cement on x-ray. Dr. Ringer, who uses this technique, said he has not encountered complications involving cement leakage.

Treatment of one vertebra, performed under general or local anesthesia, takes less than an hour. Mayfield patients also are asked to lie flat for two hours to ensure that the cement has hardened.

Although physicians usually use kyphoplasty and vertebroplasty to treat patients with a spontaneous osteoporotic fracture, the procedures also are applicable to other pathological fractures, such as those caused by tumors. Occasionally surgeons diagnose a tumor by performing a biopsy at the time of the kyphoplasty or vertebroplasty. This allows other specialists to treat the tumors early and more effectively, Dr. Ringer says.

The Mayfield Clinic & Spine Institute is recognized as one of the nation's leading physician organizations for clinical care, education and research of the spine and brain. With 14 neurosurgeons and a neuro-oncologist, Mayfield treats 20,000 patients from 35 states and 13 countries in a typical year. Mayfield's physicians have pioneered surgical procedures and instrumentation that have revolutionized the medical art of neurosurgery for brain tumors and neurovascular diseases and disorders.

The Mayfield Spine Institute, a subsidiary of the Mayfield Clinic, features the largest and most experienced network of spine specialists in the Midwest. Mayfield's multidisciplinary team includes board-certified physicians in neurosurgery and physical medicine and rehabilitation, as well as licensed professionals in physical and occupational therapy, chiropractic and more.

In 1998, the Mayfield Imaging Center was opened in Crestview Hills, Ky., expanding Mayfield's capabilities to include diagnostic imaging. Mayfield is affiliated with The University of Cincinnati Department of Neurosurgery and The Neuroscience Institute, a neuroscience center of excellence located at The University Hospital in Cincinnati. Mayfield has office locations throughout Greater Cincinnati and Northern Kentucky.