- The Washington Times - Monday, September 26, 2005

Helping alleviate back pain with a balloon sounds like a medical fantasy trip, possibly a joke. But Dr. Wayne Olan, an interventional neuroradiologist, knows firsthand how the device works and why it is effective.

He is one of the Washington area’s leading specialists in a procedure that involves using a tiny balloon to better position a small portion of cement into vertebrae that have fractured as a consequence of disease or a poor medical condition.

The most common cause of weakening vertebrae, or spine fractures, is osteoporosis, a thinning of the bones that occurs primarily in older people and especially among women. It also can happen to persons on steroids, smokers and cancer patients whose disease has spread from another site in the body. Bone pain often is an early symptom of the cancer.

A basic procedure doctors such as Dr. Olan use to help stabilize the spine, and thus reduce pain, is called a vertebroplasty. This involves using a needle to inject hot cement into the cracked or broken spinal bone to fill spaces that have become compressed. The cement hardens quickly and patients usually feel immediate relief and leave the hospital within hours.

And — the “miracle” part — in most cases they no longer have to rely on pain medications that often are accompanied by unpleasant side effects.

When the balloon is employed, the procedure is called a kyphoplasty after the Greek word kyphosis, meaning “hunched state.” An abnormal curvature of the spine is a frequent sign of osteoporosis in the elderly. Kyphon Inc., a California company, makes the medical devices used in this procedure, which, like vertebroplasty, is considered minimally invasive and requires only a local conscious sedation.

With kyphoplasty, a tiny balloon is guided through the needle into the incision — normally no more than a centimeter wide — and then inflated manually to raise the collapsed vertebra to a normal position. After withdrawal of the balloon, a small space is left into which the bone cement can be directed that, ideally, will support the surrounding bone and help prevent further breaks.

“It used to be that the cement had an opportunity to go in different places; the balloon makes cement deposition that much more predictable,” says Dr. Olan, director of neuroradiology and magnetic resonance imaging (MRI) at Bethesda’s Suburban Hospital. He has done more than 4,000 vertebroplasties and 700 kyphoplasties. Slightly different medical devices are used for each.

The patient, who ordinarily is referred to a specialist such as Dr. Olan with an X-ray image highlighting the problem, has an MRI exam just prior to the procedure to further evaluate the fracture and determine its age, location and configuration. (A biopsy is done during the procedure if a patient has any history of cancer.)

So-called compression fractures often go undetected unless an exam is done using radiographic and MRI machines, he explains. A fracture easily can be confused with common back pain, but if the fracture doesn’t heal on its own or is left untreated in serious cases, it can develop into a severe handicap.

“You may not take all the pain away, but presumably you take all of it away from that particular fracture,” Dr. Olan says.

Lying on his or her stomach with arms extended, the patient is conscious enough to answer questions from the doctor about how he or she is feeling —and where the pain is worse. The anesthetic is similar to that used in a colonoscopy, “only patients are a little more awake,” says Dr. Olan, who performs about 500 procedures a year to enhance spine function, half of them using the balloon.

The quality of the imaging equipment is paramount, says Dr. Mary E. Jensen, the director of diagnostic radiology at the University of Virginia Health Systems. An angiography suite is better than an operating room because of the availability of multiple levels of magnification, she says, since “everything is driven by how well you can see.”

Dr. Jensen was a pioneer along with a colleague, Dr. Jacques E. Dion, both interventional neuroradiologists, in introducing the vertebroplasty technique into this country 12 years ago. A French doctor is credited with inventing the idea of injecting a form of cement into vertebrae to relieve pain in cancer patients.

Different conditions determine whether to use the balloon method.

“If we believe the vertebral body is splintered with multiple fracture lines, we are more likely to put in a balloon,” Dr. Olan says.

Normally, patients with bone fractures have a thin, softened frame, but occasionally a doctor has a patient whose bone has hardened with disease. When the vertebrae are too hard, it may not be possible to inject the cement solution using the balloon.

That turned out to be the case with Irja Cochrane, 65, of Potomac who was treated by Dr. Olan in early August. It was the second time she had had a vertebroplasty, the last time at another hospital by another doctor. She had been on pain pills for a year and even had taken one the morning she arrived at Suburban. The procedure since has given her great relief, she reports.

A Kyphon company fact sheet says that osteoporosis causes more than 700,000 spinal fractures each year and that 50 percent of all women and 25 percent of men older than 50 will have an osteoporosis-related fracture in their lifetime. Some 5,000 U.S. physicians are trained to do the kyphoplasty procedure, the company maintains.

“Sometimes the longer the patient has had the fracture, the more the body has compensated for it. They may have changed the way they stand,” says Dr. Olan, pointing out the disadvantages of waiting too long to correct a problem. “You are dealing with an age population that has some other arthritis or degenerative change. … The population is at risk because of lifestyle. Just because we fix a fracture, we don’t take away the osteoporosis.”

One fracture is five times more likely to lead to another, according to figures he quotes from the National Institutes of Health. Post-treatment care is important for that reason, he notes, because the bones in most cases still are thin. He estimates that between 80 and 90 percent of the procedures are done on patients with osteoporosis.

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