Spine Jack or Balloon Kyphoplasty for Spine Fractures

July 28, 2021

I’ve been performing kyphoplasty since 2000. I thought it was an amazing spine procedure. An amazing procedure happens about once every 10 years and before that it was pedicle screws. Kyphoplasty has been relegated to non-surgeons at this point in time, and the indications and the idea bio-mechanically has sort of been diluted out and not understood by many of those doctors. The kyphoplasty procedure places a balloon into a recently fractured vertebral body, and I talk about recently within the last four to six weeks. I know for a fact that these fractures heal after six or eight weeks, becoming very stiff, and non-mobile. So putting a balloon in the first two or three weeks is very important.

Putting a balloon in a fractured vertebrae during the first two, three or even four weeks is very important because you can create a void where you can place a balloon in. You can raise the vertebra, end plates apart, and square it off sufficiently, creating the void, removing the balloon, and then placing cement in as a “grout” to support it. The last couple of years, I’ve had the pleasure of meeting several medical device companies through their representatives who are pushing what they call the Spine Jack.

The Spine Jack inserts a small metal device in the pedicle into the vertebral body that can be opened up and puts pressure on the end plates above and below, spreading them apart. The pressure per square inch or per square centimeter with a balloon is really diminished. The balloon takes up most of the space within the vertebral body. The Spine Jack does not.

I’m going to use some simple figures. Just an assumption, but the SpineJack may only jack up a square centimeter area of 5 or 10 percent of what the balloon does. This puts more pressure on those fragile end plates of osteopenic or osteoporotic bone that may or may not have been fractured. So what can happen is the Spine Jack can blast through those endplates or the doctor putting it in will not crank it out or “jack it up enough” to obtain a true reduction. I just read a paper, which shows the Spine Jack was “not inferior to the kyphoplasty and the balloon”, but the problem here in the paper that I read is that I did not see the timeframe for which the procedure was done.

In other words, if somebody gets injured, has a compression fracture… 50% of which we know happens from simply bending over and tying your shoes. It has nothing to do with the fall, which suggests the fragility of the bone and how soft it is. But if you get to the fracture within the first two, three or four weeks, number one, you can reduce the fracture. Number two, you can support the end plates with the balloon and substitute for that balloon a permanent placement of cement, which distributes the pressure and places it in such a way that the cement will not extrude out into the spinal canal or anteriorly. Bottom line is if the the Spine Jack, is used, it must be supplemented with cement anyway. So I see no benefit in putting something mechanical in if you’re going to use the cement anyway.

However, our smart industry has figured out that you can bill for a metal implant, and that metal implant allows a charge that really scams, I believe, the insurance company. I, for the last 20 years, have billed for a prosthetic implant using cement. And that’s exactly what it is. If you took it apart, you could pull a piece of cement out of the vertebrae much more easily because it’s one piece. So it’s a prosthetic implant. The cement is inserted softly and then hardens up and creates a device to fill the space and the void that’s created by the balloon. It’s an ingenious, mechanical idea. Unfortunately, insurance companies and Medicare are trying to reduce that reimbursement.

And so the response by industry is introduction of a metal jack, which is probably, like I said, maybe 10% of the square millimeter, or square centimeter area. So therefore it punches through, or it doesn’t reduce adequately. I think money is unfortunately driving this. Reimbursement is driving this, but I don’t think it’s a safe procedure. And once the Spine Jack goes through the endplates, what do you do? What’s the exit strategy? How much surgery is necessary should it have to be removed?

I think that’s a discussion that everyone can, hypothetically, think it’d be a disaster. I don’t have personal knowledge, but thinking through in a logical manner, it seems to me that would be a real disaster if it happened.