Archive November 2019 XX, No. 11

Trends to Watch in Spine Surgery

There are neat new options for fixing fractures, fusing bone and replacing discs.

Daniel Cook

Daniel Cook, Executive Editor

BIO

SIDE ANGLE
Joseph Blythe, MD
SIDE ANGLE Joseph Blythe, MD, performs an oblique lumbar interbody fusion (OLIF), a procedure that requires a smaller incision and less dissection than the anterior approach.

Same-day spine is one of surgery’s hottest specialties thanks to several new technologies that are making complex surgeries simpler for surgeons, more accurate and safer to perform, and less painful for patients. Let’s look at the exciting developments that are helping to push more procedures to outpatient ORs.

  • Restoring vertebrae height. Vertebroplasty and balloon kyphoplasty, the two most common treatments of vertebral compression fractures, have inherent drawbacks, according to Robert E. Jacobson, MD, a neurosurgeon and spine specialist with OMNI Spine Center in Miami, Fla.

Vertebroplasty involves injecting cement to stabilize vertebrae fractures. The treatment works in a high percentage of patients with non-displaced, compressive eggshell-like fractures. There are potential drawbacks to the technique. The cement solidifies the fracture and prevents further collapse, but also makes the bone harder than adjacent vertebrae, which are therefore more likely to fracture.

Balloon kyphoplasty was developed to address the inherent drawbacks of vertebroplasty, a balloon is slid into the fractured vertebrae and expanded to correct the deformity before the cement is injected into the space.

“Studies have shown that long-term correction of the deformity is ineffective, and the vertebrae will continue to collapse, resulting in further fracturing and recurrent pain for the patient,” says Dr. Jacobson.

Additionally, because the balloon makes a bigger hole in an eggshell fracture, surgeons must add more cement, which hardens the vertebrae and increases incidences of adjacent fractures. To solve that issue, attempts have been made to place structural support inside the vertebrae before injecting the cement.

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