Bouncing back from debilitating spine fractures: Innovative procedure uses balloons and cement

Lynn Shetley is one of more than 10 million Americans with osteoporosis, a disease marked by porous, brittle bones that can break more easily than healthy bones. Osteoporosis is most prevalent in women over 50. In fact, these women – like Shetley, who is 70 – have a 1-in-2 chance of breaking a bone due to osteoporosis.

A few years ago, while living in California, Shetley took a DXA, or dual X-ray absorptiometry, bone density scan that showed her osteoporosis was becoming more severe. 

“My physician was just watching my scores get worse and worse. My T-score went down to a minus 4.9, and it scared the hell out of me,” she said, referring to how much her bone mass she’d lost, compared with that of an average healthy 30-year-old adult.

Soon after, Shetley’s husband died, and she moved to Mount Pleasant, South Carolina, to be closer to her family. She visited a doctor who prescribed a medication to try to reverse her bone loss. After a couple of years, Shetley’s bone density scores improved, and she decided to stop receiving the twice-yearly injections of her osteoporosis drug.

“My brother was ill in California, and I went out there to try to help, and then he passed away,” Shetley said. “I was just being bounced around on airplanes and stuff. So when I had a sore back when I got home, I did not think it was really much more than a sore back, you know? And then it just kept getting worse. Bending, lifting, anything – the pain was constant, and it wasn’t getting better – it was getting worse, so then after about four weeks, I went in, and I said something to my doctor.”

Shetley had an X-ray that found she had two vertebral compression fractures (VCF) in her spine – in other words, a broken back. Then her doctor ordered an MRI to get a better look. Thor Johnson, M.D., Ph.D., an interventional radiologist at the Medical University of South Carolina, read the MRI studies.

 

“I called the primary care physician and said, ‘Hey, is your lady having a lot of pain? It looks like she’s fractured two vertebral bodies,’” Johnson said. “She said Lynn was having severe pain. She couldn’t sleep, and she was having trouble walking and that sort of thing. And then then the PCP sent the patient to me.”

Johnson recommended Shetley undergo a procedure called balloon kyphoplasty. 

Balloon kyphoplasty is a minimally invasive procedure for the treatment of spinal fractures due to osteoporosis, cancer or noncancerous tumors. Guided by live imaging, Johnson created two tiny openings at each fractured level in Shetley’s back and used a needle to insert a tiny balloon into each of the damaged vertebra. He then inflated the balloons to restore the original height of the vertebrae. Finally, he injected acrylic bone cement into the cavity left by each balloon, creating an internal cast to repair each of the fractures.

Shetley was amazed at the results of the hour-long outpatient procedure, which has undergone numerous improvements since its original launch in 1998.

Medtronic, a leading medical device company, developed the balloon kyphoplasty procedure to relieve pain, restore vertebral height and stabilize VCFs. Since its initial introduction, 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 nonsurgical management have shown that balloon kyphoplasty produced better pain relief and quality of life for patients, like Shetley, with acute VCF compared to patients treated with nonsurgical management.

 

“When you have the procedure done, the pain immediately stops. It’s just phenomenal. And I felt good, and I was walking more around the block.”

A few weeks after her procedure, Shetley had an unpleasant surprise.

“I went in for the standard follow-up, and I was shocked when he said, ‘You have another fracture.’”

So just two months after her first balloon kyphoplasty, Shetley had another, which was also successful. Johnson said this pattern is unfortunately typical of patients with osteoporosis who have spine fractures.

“Obviously, the more compression fractures you get, the more likely you are to have subsequent compression fractures,” Johnson said. “So, the first two, she got unlucky, but you know she’s had three, so the risk of having another one is very high. I’m trying to prevent her from developing a severe kyphosis, which happens to these people when they get multiple compression fractures – I’m trying to keep her upright basically. And I want to help to prevent further fractures.” 

To that end, Johnson also referred her to an endocrinologist to manage her osteoporosis.

Shetley said she counts herself as fortunate for her treatment.

“I know I’d just be hunched over with a cane if I didn’t have the kyphoplasty,” she said. “I cannot imagine what my life would be like if I didn’t have Dr. Johnson and that procedure.”