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Geraldine has dealt with her share of health problems over 90s years – cancer, stroke, glaucoma – but she takes pride in being independent. A retired nurse and mother of two nurses, she still knows how to take care of herself, but a recent bout of back pain left her at wits’ end.
“I really didn’t know what to do. All I know is that pain was so excruciating that I just couldn’t believe it,” said Geraldine, who lives in Stockton, Calif.
“I do a lot of gardening, and it was after I was doing this one bush that I noticed I had some minor pain, and then the pain gradually became worse. I had that for about four weeks, and then I had an episode where it got so severe, and I was using nerve stimulation and ice packs and ibuprofen, which did not really help.”
Geraldine has osteoporosis, an age-related degenerative condition in which the bones become brittle and weakened. She was diagnosed decades ago, while she was still working as a nurse, and after having taken the anti-osteoporosis drug Fosamax years ago, she hadn’t thought much about it.
This year, she was hospitalized for another suspected stroke and was taken to St. Joseph’s Medical Center. Doctors evaluating her performed MRI and CT scans that discovered her spine had broken in several places over the years. These injuries – called vertebral compression fractures or VCFs – occur more than 700,000 times a year, typically in patients with osteoporosis.
“These were pretty classic osteoporotic fractures,” said interventional radiologist Dr. Frank Callcott. “There were about four old fractures, and between them was a new fracture that was causing her pain. The old fractures had caused more stress on the spine, which is the reason for the latest fracture.”
Because Geraldine was still complaining of the severe and debilitating pain in her back, Callcott recommended she undergo a procedure called Balloon Kyphoplasty.
Balloon Kyphoplasty is a minimally invasive procedure for the treatment of spinal fractures due to osteoporosis, cancer, or non-cancerous tumors. In an outpatient procedure that typically takes less than an hour, Callcott made a tiny incision in Geraldine’s back to insert a tiny balloon into the damaged vertebra. He then inflated the balloon to restore the original height of the vertebra. Then he injected acrylic bone cement into the balloon to create an internal cast to repair the fracture.
Vertebral compression fractures like Geraldine’s injury traditionally were treated conservatively with bed rest, a back brace, and opioid pain medications, but Callcott said Balloon Kyphoplasty offers an aggressive approach that is appropriate for some patients.
“She’s very cognizant, very with it, and she still enjoys being able to do as much as she can,” Callcott said. “Once they're not able to do what mentally keeps them going, they quickly deteriorate. If they're not really mobile and it doesn't bother them that much, then leave it alone. It’s the ones who still want to be mobile, to continue their lifestyle – that's critical to maintaining their health.”
Medtronic developed balloon kyphoplasty, a minimally invasive procedure that reduces and stabilizes VCF related to osteoporosis, cancer or non-cancerous tumors. Since the initial technology launched in 1998, Medtronic has developed better balloons, an improved cement delivery system and added access tools shown to reduce hand radiation exposure for the surgeon. 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 patients treated with non-surgical management. 1-4
Although the complication rate for BKP is low, as with most surgical procedures, serious adverse events, some of which can be fatal, can occur, including heart attack, cardiac arrest (heart stops beating), stroke, and embolism (blood, fat, or cement that migrates to the lungs or heart). Other risks include infection; leakage of bone cement into the muscle and tissue surrounding the spinal cord and nerve injury that can, in rare instances, cause paralysis; leakage of bone cement into the blood vessels resulting in damage to the blood vessels, lungs, and/or heart.
Geraldine said her pain had completely resolved, where it had been an 8 or 10 out of 10 before she had the Balloon Kyphoplasty. And she is eager to share her story.
“I walk well, I’m able to get out and walk in front of my home, and I’m able now to get around. I couldn’t before with the pain. It was really bad. But I was amazed at the procedure. I’d certainly like to see more people aware of this procedure because I’m sure there are a lot of people out there who could benefit from it. It’s a wonderful procedure.”
Callcott said he is having meetings with emergency department physicians at St. Joseph’s to raise awareness that patients who report to the ER with sudden, severe back pain might have vertebral compression fractures. Some of those patients could be candidates for Balloon Kyphoplasty, he said. “It’s a simple thing, but identifying and treating patients who are appropriate for this procedure has a big-time benefit.”
Now that she's back on her feet, Geraldine said she is being careful to avoid any more fractures.
“Well, I’m staying out of the bushes! I promised my children that – no more gardening.”