Back killing you? Try kyphoplasty

Greenport doctor Frank Adipietro injects surgical cement into the damaged vertebrae of an 87-year-old woman suffering from chronic back pain for years. The procedure, called kyphoplasty, was recently criticized by the New England Journal of Medicine.

A few weeks ago, Marian Geoghan’s back started killing her.
The 87-year-old resident of Peconic Landing in Greenport said she’dsuffered from back pain on and off for years, but only recently didit take a turn for the worse. She wasn’t sure what was causing it,but she knew she didn’t want to go through any major surgery.
She also didn’t want to take measures such as massage oracupuncture that could be too conservative to ease her chronicpain. Ms. Geoghan said she had learned that lesson about threeyears ago, when she let a fractured rib heal on its own.
“I was laid up for three months in the summertime,” she said.”There wasn’t much I could do for it other than painkillers andrest.”
Her solution this time around was to see Dr. Frank Adipietro,interventional pain management specialist at Eastern Long IslandHospital in Greenport. He recommended that Ms. Geoghan go through aminimally invasive surgical procedure for spinal bone fracturescalled balloon kyphoplasty.
“This lady has a history of compression fractures,” he said beforethe surgery last Friday. “Right now, she has one that has beentroubling her for weeks, and it’s been very painful.”
Osteoporosis causes more than 700,000 spinal fractures each year inthe U.S., more than twice the annual number of hip fractures,according to the National Osteoporosis Foundation. Because of thecomplexity of back pain, Dr. Adipietro added, about two-thirds ofthese fractures go undiagnosed or untreated. But once the correctdiagnosis is made, kyphoplasty can take away back pain almostimmediately, the doctor said.
“This is a situation where we can take a patient who has been incomplete pain and get her right back on her feet within 24 hoursand living a regular lifestyle, which is the whole key to thesepain management procedures,” he said. Ms. Geoghan “has a newfracture which has not been healing on its own, in fact it’sgetting worse. She’s the perfect candidate for this type ofprocedure.”
During the 20-minute surgery — which requires only a lightsedative for the patient — cement is injected into the fracturedbone through tiny tubes while balloons open up tiny cavities in thebone that the cement can go into safely, he said.
“With other techniques, where you don’t use a balloon, the cementspreads straight into the bone and can sometimes go in a haphazardway,” Dr. Adipietro said. “And what causes the pain is themicrofractures of the bone. The cement takes about an hour to cure,then it stabilizes the fractures in the bone and the pain goesaway.”
Patients who sign up for kyphoplasty range from the elderly to the”16-year-old cheerleader who herniated a disk to the long distancerunner in his 20s to people in car accidents,” Dr. Adipietro said.”Anyone who needs pain management.”
Kyphoplasty — and a similar procedure called vertebroplasty, whichis also offered at Eastern Long Island Hospital — recently cameunder fire from a clinical study published in the New EnglandJournal of Medicine. The study found a lack of data to support theclaim that the procedure will result in an “immediate and sustainedreduction in pain.”
“Not only is the short-term efficacy of vertebroplasty unproven,”the Journal reported, “but there are also several uncontrolledstudies suggesting that vertebroplasty may increase the risk ofsubsequent vertebral fractures, particularly in vertebrae that areadjacent to treated levels, and sometimes after cement has leakedinto the adjacent disks.”
 Dr. Adipietro called the study, which was reported in The NewYork Times, “unfortunate.”
“Here’s all these people with broken bones, and they don’t knowwhat to do,” he said. “What can happen after the procedure is thatthe pain caused by the bone fracture goes away but different typesof pain associated with standard back issues then begin to pop up.Researchers obviously picked this topic and said, ‘OK, does thiswork better than conservative measures?’ Well, those of us who dothe procedure almost on a daily or weekly basis can tell you thatwe have patients out there that would be in chronic pain if thisprocedure were not done.”
 Minimally invasive surgery is always better than the oldmethods of “opening the back up” to fix a fractured bone, Dr.Adipietro added.
 “Sometimes people would be in body casts for three to sixmonths,” he said.
In Dr. Adipietro’s view, having the procedure done when a person isalready in chronic pain can’t hurt — because it isn’t going to getworse after the quick and simple operation, he said.
Two days after her operation, Ms. Geoghan said that she wasn’tquite comfortable yet but she wasn’t in as much pain as she hadbeen three weeks before.
 “It’s day by day,” she said. “Today is better than the daybefore. Hopefully by the end of the week I’ll feel muchbetter.”
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