Most patients leave the hospital or surgery center in a matter of hours after the procedure
By: Gerard A. Compito, M.D., in collaboration with Gloria N. Beck
For a person with advanced osteoporosis, a task as simple as opening a window can result in crippling back pain.
Osteoporosis is a disease in which bones gradually deteriorate, making them brittle and more likely to break. A fall or any movement that places abnormal stress on the back, such as tugging at a window, might be enough to fracture vertebrae, the bones that make up the spinal column. A severe fracture can cause a vertebra to collapse, a condition known as a spinal compression fracture.
Each year an estimated 700,000 spinal bone fractures occur in the United States, most often in women over 60, who are at greatest risk for osteoporosis, according to the Society of Interventional Radiology. One in four women over the age of 50 will suffer a spinal fracture.
A decade ago, a patient with a spinal compression fracture generally had two choices: She could try to relieve the pain with rest and medication and hope the bone healed well or endure complicated back surgery. Today, a minimally invasive procedure, known as vertebroplasty, makes it possible to alleviate pain for 85 to 90 percent of patients. Most patients leave the hospital or surgery center in a matter of hours after the procedure.
When a vertebra breaks, the fracture allows a small amount of movement within the bone. This grinding motion irritates tiny nerve endings, causing pain that leaves some patients unable to walk or perform many daily activities.
During vertebroplasty, sterile medical cement is injected directly into the bone to, in essence, glue it back together. For many patients, this provides almost immediate pain relief.
If a patient is suspected of having a compression fracture, he or she will first have an MRI or bone scan to verify the fracture and determine approximately how long ago it occurred. Vertebroplasty is not as successful for fractures older than six to 10 months, which may have already healed to some extent.
Once the fracture is identified, pain medicine and rest are still the first line of treatment. If the pain can be controlled or subsides within the first month of diagnosis, further treatment may be unnecessary. If the pain persists, vertebroplasty should be considered.
A patient undergoing vertebroplasty is awake but sedated with intravenous medicine. A local anesthetic is injected in the area of the back, where a tiny incision is made.
Guided by a live X-ray image, the physician inserts a needle about the size of a stirring straw through the back and into the fractured vertebra. Medical cement is injected through the needle into the bone. The cement hardens within minutes, creating a solid vertebral structure once again.
The entire procedure takes about an hour, and most patients spend about two hours in the recovery room before they are sent home. For nearly 90 percent of patients, the procedure either eliminates their pain or allows them to reduce the amount of pain medicine they need to feel comfortable.
The main risk for patients following the procedure is that because the repaired bone has been solidified, it may place additional stress on nearby bones. If those surrounding vertebrae are also weakened by osteoporosis, they may be prone to fracture.
It is also important for patients to understand that vertebroplasty is meant only to treat pain. It cannot be used to prevent fractures. It also does not restore the original size of a compressed vertebra. That means a patient with a curved spine caused by osteoporosis will not see any improvement in her posture.
A closely related procedure known as kyphoplasty is intended to help restore the height of a compressed vertebra and potentially improve posture. During kyphoplasty, a tiny balloon is inflated within the vertebra fragments to lift them before the medical cement is injected. This procedure carries its own risks and is typically performed under general anesthesia.
While vertebroplasty is mostly used for older patients with osteoporotic fractures, it can also help younger patients with spinal compression fractures. Diseases such as certain cancers can weaken the backbone, putting patients at greater risk. Steroids used to treat conditions such as lupus, asthma and rheumatoid arthritis may also make bones more brittle.
Vertebroplasty was first performed in France in the mid-1980s, but it has only gained widespread use in the United States during the past five to seven years. It is now administered by physicians specializing in fields including interventional radiology, anesthesiology, orthopedics and neurosurgery.
To find a University Medical Center at Princeton physician who performs vertebroplasty, call (888) 742-7496 any time, day or night.
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May is Osteoporosis Awareness Month. Osteoporosis is a major health threat for people over 50. In the United States, an estimated 10 million people have the disease and almost 34 million more have low bone mass, placing them at increased risk for osteoporosis. Princeton HealthCare System will host "Women’s Wellness: Osteoporosis Information Session" from 7 to 8:30 p.m. on Wednesday, May 17, at Princeton Fitness & Wellness Center in the Princeton North Shopping Center, 1225 State Road, Montgomery. Gina C. Del Giudice, M.D., FACR, FACP, board-certified in rheumatology and internal medicine, will discuss the prevention, symptoms and treatment of osteoporosis in women.