Melanie Cole, MS (Host): Welcome to Back To Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back To Health features, conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And today, we're highlighting kyphoplasty for spinal compression fractures. And joining me is Dr. Dan Vu. He's an Assistant Attending Anesthesiologist at New York-Presbyterian Hospital weill Cornell Medical Center and an Assistant Professor of Clinical Anesthesiology at Weill Cornell Medical College Cornell University.

Dr. Vu, thank you so much for joining us today. And before we get into kyphoplasty, which I know our listeners are interested in, because it's really revolutionized a lot of the treatments that we used to think about. Explain a little first about vertebral fractures. What exactly is a spinal compression fracture? How does something like that happen?

Dan Vu, MD: Hey, Melanie. Thanks for having me. I'm certainly excited to talk about vertebral fractures and the role for kyphoplasty. So, I think to really understand spinal compression fractures, you must first take a step back and look what the spine looks like in everyday life. So, I have a model here, try to get it all on the camera. But your backbone consists of 33 different bones called vertebrae. So as you can see, all these bones stack on top of each other. They provide support for your body as you go about everyday life. They allow you to stand upright, bend over, twist, bend, and move, while protecting the spinal cord and the important spinal nerves that travel from your brain to the rest of your body, to your arms and your leg.

So if we take a closer look at one of these vertebrae, each one of these vertebrae holds significant amount of load. Normally, they're very strong. However, when they're weakened, you can have what's called a compression fracture, where the vertebral body here, the part in front, kind of compresses down and gets crushed.

So, how does it happen? So most commonly, I see it in more older patients where they have a condition called osteoporosis, where their bones get more brittle and fragile over time. So, osteoporosis is a condition where our bones gradually lose density and strength. And this can lead to fractures, softening of the bones, and these spinal compression fractures. So in patients with osteoporosis, sometimes even normal, everyday activities can lead to these compression fractures. For example, some patients will get a compression fracture after sneezing, coughing, heavy lifting, or even something as simple as going over a bump in the road. Other times in patients with osteoporosis, those fractures can occur over time where a small fracture occurs. And you get more and more fractures on top of that, leading to a more chronic compression fracture over time. In younger patients, we do see it sometimes in areas where there's a higher velocity or mechanism of injury such as trauma, a fall, or a sports injury. And in some rare cases, it may occur in contexts such as cancer.

Melanie Cole, MS: I love the anatomical model. That was awesome. That was a really great explanation and you explained it so very clear. So Dr. Vu, how do we know? Because especially for people in my age group and above, and people with osteopenia and osteoporosis, we get back pain, we get pains. And we're like, "Ugh," and sometimes it's really bad and it hurts really bad. But how do we know that it's a fracture versus typical back pain or, you know, how people say, "I threw my back out," or a slipped disc, a bulging disc, something along those lines? What would differentiate something where we go, "Okay, this could be something serious like a fracture"?

Dan Vu, MD: So, sometimes it can actually be a little tricky. Because a lot of the things I see patients with back pain for sometimes, it is acute. And that's kind of what we expect with a vertebral compression fracture, where out of nowhere patients will report sudden onset pain. Some patients say, "I woke up with this pain," or they like lean forward and suddenly they have pain. So, it can be hard to differentiate between kind of these compression fractures and other types of back pain.

So, this is where things like imaging come in. So, X-rays, we can see compression fractures on X-ray. MRI is another modality that we utilize to assess these compression fractures. And the MRI, the neat thing about the MRI is that it allows us to see if that fracture's old or new. So, kind of the timing between the symptoms and the imaging findings leads us to be able to tell if this is a compression fracture that's causing your pain.

Melanie Cole, MS: So, doctor, once you've detected what's going on, what used to be the standard of care for patients, since it happens a lot in the elderly and there might be limiting factors, what was the standard of care? What do you do before you look to surgical intervention?

Dan Vu, MD: In many cases, the standard of care is conservative care. That's what we start with before we jump into more interventional options. So, what does conservative care look like? It consists of things like rest, activity, modification, medications, sometimes back braces and time, just allowing time for that fracture to heal.

Some of the medications that are utilized are things like over-the-counter anti-inflammatories, such as ibuprofen, naproxen, other times other over-the-counter pain medications such as acetaminophen. If the pain is more severe and it's more debilitating, then we look for stronger medications such as prescription opioids, which are safe to use in a short period of time. And in some cases, the pain is so debilitating, it would necessitate going to a hospital, getting medications through your IV if the oral medications aren't enough.

I'm glad you brought up the point with the elderly. Because a lot of times, some of the side effects from these medications are either unsafe or not tolerated by more elderly patients. So, some of these side effects, especially with opioid medications, include things like sedation, confusion, difficulty urinating, increased risk of falls. So of course, in the elderly, we try to be judicious with what we utilize and be as safe as we can.

And then, for surgical intervention, namely the kyphoplasty, we utilize that in cases where the pain is so bad where other conservative management just doesn't cut it, or the side effects are just too bad and they're not able to tolerate those medications. So, those are the cases we reserve surgical intervention, such as kyphoplasty for.

Melanie Cole, MS: Well, I'm glad you brought up the risk of falls too, because then that increases the risk for hip fractures. So, I mean, we're looking at all those things. Okay. Tell us what kyphoplasty is. How does it help in this situation?

Dan Vu, MD: So, like I mentioned, kyphoplasty is a procedure that we utilize for patients with vertebral compression fractures that have not been responsive to conservative therapies. While overall kyphoplasty is a safe procedure, as with any procedures, there are risks associated with it. So, we save it for our cases where conservative management has either not worked or quality of life remains affected, or they're not able to tolerate the medication side effects.

So, what kyphoplasty is, going back to the model here-- So, as I mentioned, the vertebral body here in front is what gets compressed and crushed, during these compression fractures. What kyphoplasty is we utilize a small instrument to access the vertebral body in front. Through that, we place a balloon. And the purpose of the balloon is to expand that compression fracture, restore some height that was lost during the process of the compression fracture. And then, once that balloon is in place, we deflate it. That leaves a cavity, and we insert cement through it. The purpose of the cement is to stabilize that fracture, restore that height and help with your pain afterwards.

Melanie Cole, MS: Isn't that amazing? I'd like to have some of my height restored. I'm four-foot-nine. Can you do that for me please? That would be great.

Dan Vu, MD: I wish.

Melanie Cole, MS: So, okay, as we think about this procedure, speak about patient selection, because it's really not necessarily for everybody, right? Or is it?

Dan Vu, MD: Yeah. And I'm glad you brought up the concept of patient selection. Because I think, for my field personally in interventional pain, patient selection is a very important part of what we do, choosing the right therapy for the right patient at the right time. So, patient selection, I guess, I should take a step back and talk about kind of the timeframe for healing for these compression fractures.

So, a lot of these compression fractures, they heal over time and the pain improves anywhere from four to six weeks. Sometimes it may take a couple months for it to fully heal and for the pain to fully resolve. As I mentioned, the patients that would benefit most from a kyphoplasty are those who have severe incapacitating pain that affects their quality of life, patients who can't tolerate the medications that are prescribed or given to them for the pain. So, those patients are good candidates for kyphoplasty.

And another factor that we look for is an acute or subacute compression fracture, meaning from anywhere within the past four weeks, three months, as it's been shown that those patients do better after a kyphoplasty. So, those are the patients we select for. Those are the patients that are excellent candidates for a kyphoplasty, and those are the patients that would benefit the most from a kyphoplasty.

Melanie Cole, MS: Dr. Vu, speak about the procedure a little people are afraid of back procedures. I mean, you know, you hear all kinds of horror stories. Is this under general anesthesia? Is it something you have to spend the night in the hospital for? Tell us a little bit about the procedure and the recovery then, how long before you're walking, how long before you're able to drive. Tell us just a little bit about the actual event itself.

Dan Vu, MD: Yeah. So, the kyphoplasty itself, the nice thing about it is what we call a minimally invasive procedure. So, it's not a big open back surgery. It's not a huge spine surgery. It is an outpatient procedure, meaning you come in, the procedure gets done, you go home the same day. It can either be done under sedation or general anesthesia. So, that just kind of depends on patient factors, depends on the person performing it, and depending what kind of everyone involved is most comfortable with and most experienced with.

So, the kyphoplasty itself, like I said, it's a quick procedure. It takes anywhere from 30 to 60 minutes per vertebral level that we're treating. You come in, it takes a few hours, you recover a little bit from the anesthesia, and then you go home the same day. Recovery, the nice thing about kyphoplasty is the pain relief comes pretty quickly. I've had some patients get pain relief before they leave. While other patients may take a few days for that pain effect to be fully realized, you will be a little sore from the procedures just in the areas in the back, where those instruments went through, but that goes away within a few days to a few weeks. And activity limitations aren't really any activity limitations, what you were limited in before. Hopefully, you'll be able to do more once you leave, but there's no strict limitations. You're able to walk the same day, able to get back to your life sooner than you would without a kyphoplasty.

Melanie Cole, MS: That's amazing, Dr. Vu, that really is unbelievable. So, I'd like you to give us your best advice, first of all, for patients who may be at risk, for people who may be at risk for osteoporosis, women in my age group, men, even for athletes that might be at risk for these type of fractures. Your best advice about prevention in the first place would be fantastic.

And then, I'd like you to summarize the importance of discussing with your provider these types of treatments, because kyphoplasty can really be a quality of life-changing procedure. Something that helps someone who's really been living with some pain get back to their daily activities, their functional activities, and live that higher quality of life.

Dan Vu, MD: Yeah. I'm glad you brought up the concept of prevention. Because obviously, ideally, these fractures would happen in the first place, anytime we do these kyphoplasty, we always ask what's causing that fracture. In a lot of cases, it's osteoporosis, especially in older patients. So after we do the kyphoplasty, we always make sure they have good care for the osteoporosis. That means seeing a doctor who's experienced in treating osteoporosis, whether that's your primary care provider that's comfortable with it, an endocrinologist, or a specialist orthopedic doctor that is specialized in it as well.

So, things they may do would be getting a DEXA scan. So, a DEXA scan is a bone density scan that looks at how your bone health is, and it can diagnose and identify osteoporosis. If you are identified to have osteoporosis, there are certain medications that your doctor will put you on to improve your osteoporosis and hopefully prevent any future fractures down the road.

Other things that are important that anyone can do to prevent these fractures, prevent osteoporosis from worsening in the future, or be it things like keeping a healthy weight, avoiding excessive alcohol intake, avoiding smoking, because that can decrease the speed at which these fractures heal.

Weight-bearing exercise is an another important thing that helps maintain strong bones. And by weight-bearing, I mean activities that get you on your feet, that put weight on your feet and knees and your entire body to kind of exercise those bones themselves and strengthen them. And then, other things we do to maintain regular contact with your doctor that's treating your osteoporosis.

Melanie Cole, MS: Great advice, Dr. Vu. Thank you so much for joining us today and not only sharing your incredible expertise, but you're really a great educator and you explained everything so well. You even brought props. So, thank you so much for joining us today. And Weill Cornell Medicine continues to see our patients in-person, as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

That concludes today's episode of Back To Health. We'd like to invite our audience to download, subscribe, rate, and review Back To Health on Apple Podcast, Spotify, iHeart, and Pandora. For more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. There's so many great podcasts there. Until next time, I'm Melanie Cole.

On the Mind promo: Listen now to On The Mind, the new podcast from Weill Cornell Medicine, discussing the latest hot topics in psychiatry, psychology, and mental health. Join Dr. Daniel Knoepflmacher as he explores recent research in cutting-edge clinical care with leading scientists and providers. Learn new initiatives and community wellness and how to process your mental health journey while exploring everything on the mind. Subscribe wherever you listen to podcasts.

Disclaimer: All information contained in this podcast is intended for informational and educational purposes. The information is not intended nor suited to be a replacement or substitute for professional medical treatment or for professional medical advice relative to a specific medical question or condition. We urge you to always seek the advice of your physician or medical professional with respect to your medical condition or questions. Weill Cornell Medicine makes no warranty, guarantee, or representation as to the accuracy or sufficiency of the information featured in this podcast, and any reliance on such information is done at your own risk.

Participants may have consulting, equity, board membership, or other relationships with pharmaceutical, biotech, or device companies unrelated to their role in this podcast. No payments have been made by any company to endorse any treatments, devices, or procedures. And Weill Cornell Medicine does not endorse, approve, or recommend any product, service, or entity mentioned in this podcast.

Opinions expressed in this podcast are those of the speaker and do not represent the perspectives of Weill Cornell Medicine as an institution.