Mr Michael Kotrba - St Anthony's Hospital

Balloon KyphoplastyMichael KotrbaMD Bsc (Hons)Consultant Orthopaedic & Trauma SurgeonDepartment of Orthopaedic and Trauma Surgery, Mayday University Hospital, Croydon, Surrey.St. Anthony’s Hospital, North Cheam, Surrey.Shirley Oaks Hospital, Croydon, Surrey.

OsteoporosisNormal boneOsteoporotic boneMr Michael Kotrba

Vertebral fractures: ThreeformsWedgeWedgeBiconcaveCrushMr Michael Kotrba

Osteoporotic VertebralFracturesPrevalence Prevalence in the EUis high 2000: 23,7 million 2050: 37,3 millionIncidence Incidence is low 440 000 diagnosedVCFs per year inthe EUMr Michael Kotrba

VCFs are not easy to detect, even on X-rayHpHaHpHa•Genant at al. JBMR 1993;8(9): 1137-48Mr Michael Kotrba

Incidence of vertebral fractures 1T4T5T6T7T8T9T10T11T12L1L2L3L41 2 3 4 5 6 7 8Fracture prevalence (%)1. Nevitt MC et al. Bone. 1999;25:613–619.Mr Michael Kotrba

Biomechanics of VCFThe center of gravity (G)moves forwardLarge bending momentcreatedPosterior muscles andligaments mustcounterbalance increasedbendingOsteoporotic anteriorspine must resist largercompressive stressesGMr Michael Kotrba

Biomechanics of VCF Change in balance 1 Increased muscle fatigue 1Increased risk of falls andadditional fractures 11Gold et al, Osteoporosis 1989Mr Michael Kotrba

Risk of subsequent FractureRR with 1 prevalent deformity is = 3RR with 2 prevalent deformities = 10RR with 3 prevalent deformities = 23when compared to patients withoutbaseline deformityMr Michael Kotrba

Consequences of VCF’sMr Michael Kotrba

Cost Conservative treatment :• Analgesics• Bedrest• bracing VCF patient :10-20 days in hospital Huge cost for doing nothing! After Balloon Kyphoplasty: Patient will return homeafter 1 day and needs less analgesicsMr Michael Kotrba

Balloon KyphoplastyMr Michael Kotrba

Balloon Kyphoplastyis a minimally invasiveprocedure to treatvertebral bodycompression fractures.To date, more then300,000 fractures onmore then 250,000patients worldwideare treated with BKPMr Michael Kotrba

Balloon Kyphoplasty goalsThe technique is designed to: Reduce and stabilise the fracture correct spinal deformity prevent new fractures Provide immediate & sustainedpain relief and improved quality oflife.Mr Michael Kotrba

Bone Access Local or general anesthesia Minimal invasive:• 2 incisions of 1cm• 2 canula’s of 4.2mmdiameter Transpedicular orextrapedicular approachMr Michael Kotrba

Bone Access1 12 31. Via a Jamshidineedle and a K-wirethe right trajectory isdefined2. The Osteointroduceris inserted over theK-wire3. The channel for theballoon is preparedMr Michael Kotrba

Fracture reduction& height restorationMr Michael Kotrba

Balloon inflation‘En masse’reductionMr Michael Kotrba

Cavity CreationSAFETY!Mr Michael Kotrba

Fracture stabilisationMr Michael Kotrba

Fracture stabilisationMr Michael Kotrba

Fracture StabilisationEFFICACY! Viscous bone cements designed & approved foruse in Balloon Kyphoplasty Using the safe low pressure BFD filling technique‣ For immediate & sustained pain reliefMr Michael Kotrba

Balloon Kyphoplasty & Time Treating 1 level takes60min; about 30 min peradditional level Short hospital stay; alsopossible on outpatient basis Almost immediate pain reliefMr Michael Kotrba

Indications for Balloon KyphoplastyPainful vertebral compression fractures inthe lumbar or thoracic region, due to:• Primary osteoporosis• Secundary osteoporosis• Osteolytic lesions due to multiple myelomaor bone metastasis• TraumaMr Michael Kotrba

Patient OutcomesPatient Outcomes include: Vertebral body height restoration Angular correction of deformity Significant reduction in pain (95%) Reduced number of days in bed Improved quality of life Improvement in activities of daily living Improvement in mobility High rate of patient satisfactionMr Michael Kotrba

VASPAIN Ledlie : 96 pat– 104 proceduresVisual Analog Pain Scores10.008.008.606.004.002.002.702.30 2.101.50 1.400.000.00 0.25 1.00 3.00 6.00 12.00Time (months)Mr Michael Kotrba

Height restoration Ledlie: vertebral body was restored to 87% of itsoriginal height8986 859087 8966650 1 6 12 0 1 6 12anteriorMr Michael Kotrbaposterior

Height restoration Garfin : abstract at NASS 2001 2194 Balloon Kyphoplasty proceduresin 1439 patients 72% of lost vertebral height wasregained when fracture was treatedwithin 3 monthsMr Michael Kotrba

ExampleMr Michael Kotrba

Kyphosis angle Philips : 29 patients – 37 procedures mean of 8,8° of correction of local spinalKyphosis 30 of 52 fractures (17 patients) had a >5°correction with a mean of 14,2° fracture-age< 3 months : association with degreeof deformity correctionMr Michael Kotrba

What means 8°?Mr Michael Kotrba

Differences to Vertebroplasty Less safe:• Leakage rate• complications No height restorationMr Michael Kotrba

Patient Satisfaction: U.S. Study Reports patient satisfaction with theoutcomes of the Balloon Kyphoplastyprocedure Measured on a scale of 1 – 201 = completely dissatisfied20 = completely satisfiedRESULT: 17.5 at one week and holding at 2 yrsKyphon U.S. Study. Data on file at Kyphon Inc.Mr Michael Kotrba

Why Wait ?T-12 VCFJanuary 2003Courtesy of M Hisey, MDTexas Back InstituteFebruary 2003May 2003Mr Michael Kotrba

Back pain isnot normal !Mr Michael Kotrba

Thank you.Michael KotrbaMB Bsc (Hons)Consultant Orthopaedic & Trauma SurgeonDepartment of Orthopaedic and Trauma Surgery, Mayday University Hospital, Croydon, Surrey.St. Anthony’s Hospital, North Cheam, Surrey.Shirley Oaks Hospital, Croydon, Surrey.