Treatment For the Pain of Spinal Fractures Caused by Osteoporosis
Vertebroplasty is a treatment procedure developed by interventional radiologists to stabilize broken bones in the spine caused by osteoporosis. In the procedure, a hollow needle about the size of a cocktail straw is inserted through the skin and into the collapsed vertebrae. A surgical bone cement called poly-methylmethacrylate is injected through the needle into the bone to stabilize it. The cement hardens, stabilizes the bone and prevents further collapse. This stops the pain caused by bone rubbing against bone. Often, more than one crushed vertebrae can be treated in a single procedure. Surgery is not required because the doctor is able to guide the needle to the right spot using special X-ray equipment. Vertebroplasty takes from one to two hours to perform depending on how many bones are treated. The procedure may be performed with a local anesthetic that numbs the area to be treated, or the patient may be given moderate sedation.
Vertebroplasty can be performed in an outpatient surgical center, although most patients have the procedure done in a hospital and may go home several hours afterwards.
Some patients experience immediate pain relief after vertebroplasty. Most report that their pain is gone or significantly better within 48 hours, however residual muscle spasms are fairly common following the procedure and may last several days. Normally, an over the counter pain reliever may be suggested to help alleviate the discomfort caused by the spasms. Many people can resume their normal daily activities immediately. It is also important to remember that activity such as walking, swimming, and light stretching will keep your back limber and strong and not only help with recovery but help prevent future injuries.
Q: Is the procedure safe?
A: Vertebroplasty is very safe. Although it is a relatively new treatment in the U.S., vertebroplasty has been performed for more than a decade at several centers in France with excellent results. The injection technique also has been successfully used for a number of years in the U.S. to treat other conditions in the spine. For example, it is used to treat cancer and blood vessel abnormalities. The bone cement used to stabilize the fractured vertebrae has been shown to be safe through many years of use in joint replacement surgeries and other orthopaedic procedures.
Q: Who is a candidate for vertebroplasty?
A: People who have suffered recent compression fractures that are causing them moderate to severe back pain are the best candidates for vertebroplasty. In some cases, older fractures may be treated, but the procedure is most successful if it is performed soon after the fracture occurs. The procedure is not used to treat chronic back pain or herniated disks.
Q: How successful is vertebroplasty?
A: Studies have shown that from 75 percent to 90 percent of people treated with vertebroplasty will have complete or significant reduction of their pain.
Q: What are the risks or complications?
A: Vertebroplasty is a very safe procedure with few risks or complications. In many studies, no complications were reported. As with any medical procedure, the possibility of complications will depend on the individual patient. For example, patients with tumors in the spine or with other serious medical conditions may be at higher risk for complications from vertebroplasty. You should always ask your doctor to discuss risks and complications with you before you undergo any procedure.
Q: Will vertebroplasty treat or prevent loss of height or "widow’s hump"?
A: After a vertebra has fractured, there is typically a loss of only 20 percent to 30 percent of the height of the bone. But over several weeks, fractures may reoccur and the vertebra flattens out, until eventually there’s a 70 percent to 90 percent loss of height in the bone. Gradually, the back hunches over and the person loses height, especially if several vertebrae are involved. Vertebroplasty cannot reverse this loss of height or kyphosis (often called "widow’s hump) in individuals who already have these conditions.
Some studies suggest that early treatment of spinal fractures with vertebroplasty can strengthen the spine and improve the posture, which may help prevent further fractures that lead to height loss or kyphosis. Currently, however, there is no evidence to prove that the procedure will prevent these problems. However, new research on the horizon is looking at ways to solve these problems.
On the Horizon
A couple of new approaches to vertebroplasty are in development:
- Researchers are looking into new cements that will convert to bone and stimulate bone growth.
- Vertebroplasty may also be used preventively in the future to treat fragile, osteoporotic vertebrae in high-risk patients before they fracture.
Source: Society of Interventional Radiology © 2003, www.SIRweb.org