can be drilled into the affected bone, permitting introduction of
sterile hydraulic balloons, which in turn are then inflated, creating
cavities within the bone. The surgeon then performs low-
pressure filling of the treated vertebra with a bone cement, which
in turn stabilizes the bone from the inside out, in a manner which
typically results in an excellent to complete relief of fracture pain.
Today I did two such kyphoplasties. One on an 87-year-
old widow, a fiercely independent steward of her home and
property, who was walking about with no pain within a couple of
hours of performing her T9 kypho; and the other on a 76-year-
old Vietnam war veteran, who fought with the 7th Calvary at La
Drang and survived (the intense fire fight depicted in the epic
war movie, “We Were Soldiers Once”). His L3 kypho went very
well, and he can now move on, and keep up the good fight.
Like every surgical procedure, its successful completion
is a matter of art and science. The set up for this procedure
requires use of a fluoroscopically compatible table, I prefer the
use of two C-arms for the procedure which eliminates the extra
time required manipulating this large x-ray camera if only a single
device is used. I prefer to use two access points to treat the
bone as this increases the capacity to fill the bone properly top
to bottom and side-to-side, which in turn increases the likelihood
of relief of bony pain. I use a small amount of vancomycin with
my orthopedic cement and in the 100’s and 100’s of cases I have
performed, have never had a single infection. In spite of the
close proximity of either the thoracic spinal cord or cauda equina,
and the close proximity of the lungs and major blood vessels,
I have never had an instance of injury to these structures. To
increase procedure safety, it is performed with neural monitoring.
The incisions are typically small enough to be closed by a
single suture. Although the procedure takes close to an hour
to accomplish, the actual cement augmentation portion of the
procedure usually is for only about 10-12 minutes. The rest of the
time is for set up with positioning, prepping and draping.
Performance of kyphoplasties, like the two procedures I
accomplished today, are as close to performance of magic as I
can get as an orthopedic surgeon. To kypho or not to kypho—
that is a decision only an experienced spinal specialist can make.
It can make all the difference to keeping the Golden years with
as much promise, independence and enjoyment as is possible.
-John P. Masciale, M.D.
Contributed by:
JOHN P. MASCIALE, M.D.
Dr. Masciale is a board certified
orthopaedic surgeon with a
subspecialty focused in adult spinal
surgery. He is a graduate of Cornell
University and received his Doctor
of Medicine degree from the State
University of New York Downstate
Medical Center in 1985.
After completing his orthopaedic
residency at Downstate, Dr. Masciale
completed a fellowship in spinal
surgery at the Alamo Bone and Joint
Clinic in San Antonio, Texas from
1990-1991.
He has been in practice with South
Texas Bone & Joint since 1991 and is
the longest practicing spinal surgeon
in the City.
601 Texan Trail, #300
Corpus Christi, TX 78411
(361) 854-0811
southtexasboneandjoint.com