Dr. Ari Salis, the director of interventional radiology and chairman of radiology at Concord Hospital, discusses interventional radiology and how it can help treat vertebral compression fractures.

What is an interventional radiologist?

An interventional radiologist uses all of the traditional radiology modalities, such as computed tomography and ultrasounds, to not only diagnose, but also treat. Board-certified physicians in interventional radiology (IR) specialize in minimally invasive, targeted treatments. It is an exciting field of medicine, albeit at times not well understood, because it is not tied to any particular body part or system. It is helpful to think of it as surgery without the mess; mess meaning big incisions, post-operative complications, patient pain and trauma, lengthy hospital stays, and prolonged recovery times.

What are vertebral compression fractures?

Vertebral compression fractures (VCFs) are small fractures in the vertebrae that cause a wedge-shaped appearance of the vertebra, a shortening of the spine, and forward tilt. Most often, these fractures are the result of osteoporosis; however, they can also be caused by cancer, trauma, or benign tumors. Signs of VCF would include the sudden onset of back pain with little or no trauma for an acute event, or a loss of height and kyphosis, or a curvature of the spine, as chronic changes.

What is osteoporosis?

Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue with a consequential increase in bone fragility and a susceptibility to fractures. Primary osteoporosis is age related and is usually seen in elderly patients. More females than males and more Caucasians than African Americans seem to be affected. Other risk factors include excessive alcohol or caffeine consumption and smoking. Secondary osteoporosis is often in younger patients and is usually the result of chronic steroid use due to asthma, COPD, autoimmune diseases, vasculitis, organ transplants, and irritable bowel disease. Osteoporotic fractures, including VCFs, are a large public health problem in the United States, especially with the aging population.

How is VCF treated?

Standard treatment for VCF has traditionally involved bed rest, back bracing, and pain medications; however, the clinical evidence has shown that such non-surgical treatment methods ultimately lead to higher mortality rates. Fortunately, vertebral augmentation was developed and can now be performed by interventional radiologists in a minimally invasive manner. The augmentation procedure used most often is called kyphoplasty and it involves a percutaneous injection of bone cement. An orthopedic balloon is used to gently elevate the fractured vertebra, returning it to its correct position and creating a cavity. This void is then filled with bone cement creating an internal cast to support the surrounding bone. It can be performed under general or local anesthesia in either a hospital or clinic setting. Kyphoplasty can stabilize painful VCFs, reduce back pain, and restore the vertebral body. The procedure is very well tolerated with 95 percent of patients experiencing pain relief and less than two percent suffering from complications.

Which patients are candidates for kyphoplasty?

While it has been shown that non-surgical treatment is not ideal, that is the case for symptomatic, or painful VCFs mostly. When quality of life is affected, it is time for a surgical solution. Because kyphoplasty is minimally invasive and so well tolerated, the main condition for this procedure to be considered is that the VCF(s) is symptomatic. The best candidates are those that express focal pain and tenderness upon exam that corresponds with edema seen on a bone scan or MRI. There are, however, two contraindications to kyphoplasty. A height loss between vertebrae that is greater than 70 percent would make the procedure difficult. A moderate or severe retropulsion, or a pushing back, of the posterior vertebral body cortex into the spinal cord greatly increases the chances of a major complication, and another option would need to be explored.

Dr. Ari Salis, M.D., of Concord Hospital Interventional Radiology spoke about interventional radiology and its role in treating vertebral compression fractures at the November Concord Hospital Trust “What’s Up Doc?” Donor Lecture Series. The monthly series, supported by the Walker Lecture Fund, features members of Concord Hospital’s medical staff speaking to Concord Hospital Trust donors about new and innovative medical treatments and services. You can watch Dr. Salis’ presentation on Concord Hospital’s YouTube channel at: youtube.com/concordhospital.]]>