For patients experiencing pain and a compromised quality of life, finding a procedure that offers immediate relief is a best-case scenario. That’s why physicians like Adam Romman, MD, of UTMB’s Pain Management service in the Department of Anesthesiology, find certain procedures to be so rewarding.
Dr. Romman says lower back pain is one of the most common reasons patients come to him, and there are a variety of treatment options available, depending on the source of the pain. Kyphoplasty is a minimally invasive procedure that treats vertebral compression fractures, offering near-immediate relief and long-lasting results.
“As people age and are at risk for developing osteoporosis, we see compression fractures. It could be that someone had a fall, or something as simple as sneezing in bed, and the vertebrae fracture. They become compressed. The pain can be quite severe and quite debilitating,” Dr. Romman says.
Most commonly seen in the over-60 population, a compression fracture causes a person to lose some of their height, and the resulting pain can be such that the individual cannot walk or may be unable to work.
When patients present with low back pain, an X-ray and additional imaging may be ordered to determine whether there is a compression fracture. If so, Dr. Romman and his team will consult with their spine surgery colleagues to determine next steps, and in many cases kyphoplasty is an option.
Dr. Romman explains that kyphoplasty is an outpatient procedure performed under fluoroscopy, or X-ray guidance, that takes 45 minutes to an hour on average to complete.
During that time, the physician inserts a balloon into the collapsed vertebrae to expand the area, then injects cement to fill the cavity. A new system called SpineJack is also available, using a small piece of hardware that looks like a tiny car jack, to expand the vertebrae. With these procedures, the results are almost instantaneous.
“Kyphoplasty is one of the most satisfying procedures that we do,” Dr. Romman says. “People come in, they can’t walk, they’re miserable. We do the procedure, and they are up and walking out of the hospital, feeling, if not back to normal, at least almost back to normal.”
He says patients with a recent compression fracture that having significant pain are potential candidates for the procedure. Recency is important, as patients tend to have better outcomes the sooner they have the procedure after their injury. For that reason, he cautions against spending too long on conservative management for patients with severe symptoms.
Following the procedure, Dr. Romman will see the patient for a follow-up and recommends a concurrent workup for osteoporosis. Although not every patient with a compression fracture will have osteoporosis, it is best to get confirmation so those who need treatment can begin to receive it.
“(With osteoporosis), if they get one compression factor, they're suddenly at risk for more compression fractures or a hip fracture,” he says.
He says many patients feel well with no residual pain after kyphoplasty. For those who do have pain, which may come from other issues unrelated to the compression fracture, physical therapy may be beneficial.
Dr. Romman understands that the path to a pain specialist may not be direct, and some patients may experience such severe pain that they go to the emergency room and end up in the hospital, where they would have the procedure as an inpatient.
Others may share their concerns with their primary care provider. In those cases, Dr. Romman recommends referring the patient to Pain Management as soon as possible, since expediting treatment often makes a difference.
“For anyone coming in with a painful lumbar compression, it would be a good idea to send a pain referral,” Dr. Romman says.
Pain Management procedures, including kyphoplasty, primarily take place in League City, with some in Galveston and Clear Lake as well.
 | Adam Romman, MD, sees patients at the UTMB Pain Management Clinics in Galveston, League City and Clear Lake. Learn more about Pain Management services at UTMB. |