Business Matters Fall 2018 - Page 19

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