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prevent leaving sharp edges that might pu nc t u re a ner ve membra ne a nd cause a spinal fluid leak. Ultrasonic emulsification devices facilitate bone sculpting, significantly enhance surgi- cal precision and support postsurgical recovery by reducing the chance for sof t tissue injuries that ca n cause postoperative pain and prolong the rehabilitation process. Restoring Vertebral Height According to the American Association of Neurological Surgeons (A ANS), approximately 10 million Americans have osteoporosis, and 34 million more have low bone mass, which puts them at higher risk for vertebral compression fractures, which are the most common fracture in this patient population. Surgically treating elderly patients has traditionally been challenging, so back surgery has often not been an ideal course of treatment. To surgeons on the front lines, finding an effective, minimally invasive solution to correct these injuries was of paramount importance. Kyphoplasty is a minimally invasive solu- tion to treat spinal compression fractures caused by osteoporosis, metastases and multiple myelomas, vertebral hemangiomas and vertebral osteonecrosis. It is also used to support weak vertebral bodies before surgical stabilization. "This is another procedure that revolu- tionized spine surgery when it came out," Dr. Sonstein says. "Before, bracing was the only mechanism for treating spinal compression fractures suffered by people who were typically elderly or who had osteoporosis. Fractures cause these patients to become immobile, which worsens osteo- porosis and leads to secondary effects from the fracture, such as gastrointestinal problems because of the resulting defor- mity. It's a vicious cycle that kyphoplasty can end, and those of us who have been performing it since its development years ago offer incredible precision." Kyphoplasty is a percutaneous procedure that applies functional principles of angio- plasty to correct vertebral height following a compression fracture. Using X-ray guidance, Dr. Sonstein introduces a hollow needle into the fractured vertebra. He threads a surgical balloon through the needle and inflates it, creating a cavity and restoring the vertebra to its natural height and shape. He then injects cement into the space for structural reinforcement. Kyphoplasty improves upon vertebro- plasty — another treatment for compression fractures that consists of injecting cement directly into the fractured bone through a hollow needle. "This is a safer procedure than vertebro- plasty because you have more control over the application of the cement," Dr. Sonstein says. "In vertebroplasty, surgeons had to be very careful to apply it in manners that prevented leakage, but kyphoplasty offers a more controlled application of the cement, which significantly reduces the risk of complications." Complication rates for kyphoplasty performed to correct vertebral compression fractures are less than 2 percent, according to an AANS estimate. Give the Lumbar Spine Some Space Lumbar spinal stenosis also commonly affects the elderly population, causing severe back and leg pain due to narrowing of the Instrumentation used to perform posterior lumbar fusion Dr. Sonstein examines a patient who may require surgery on her neck. COV ER FE AT UR E 8 | Long Island MD NEWS ■ M D N E W S . CO M