Vertebroplasty

Intense pain due to vertebral fractures can be Efficiently treated

Thousands of fractures happen annually due to osteoporosis in different parts of the body. A common place where fractures happen is the spine. The reason could be a fall or mere strain on the spine which can cause collapse of the vertebra causing a fracture in the spine. The vertebral fracture can be severely painful and may even instigate a disability.

Usually the first part of treatment is bed rest and pain killers. If the pain not alleviated by the initial treatment, then usually a surgery will be required. The open surgery is followed by several weeks of physiotherapy.
If more than one vertebrae collapse, it results in loss of height or stooping in the posture. Although fracture in the bones heals by itself, but sometimes the pain continues due to movement and brushing of broken bones.

Osteoporosis

This disease develops in a silent way, and comes to notice only when the bones are already too weak. When this happens, a simple sudden body movement, traction or small trauma can lead to fracture. Osteoporosis is the loss of bone mass, usually in the elderly people. Fractures in patients with osteoporosis are more common in the back bones, where the bone is very weak.

Most patients think that he pain and disability caused by those fractures is permanent, as general treatment provided very limited or no relief. For these patients who suffer from acute or chronic pain, treatment must be directed to pain management, functional rehabilitation and preservation of bone mass.

A novel treatment option is a procedure called Vertebroplasty. It was first introduced in France, over a decade ago, now it is highly accepted in USA.

Vertebroplasty

Vertebroplasty is a procedure used to treat the spine yet does not involve general anesthesia or any big cut in the skin. Vertebroplasty is a highly precise procedure in which, an interventional radiologist inserts surgical cement inside the broken bone, using highly specialized X-ray equipment. This is done by inserting a small needle into the broken bone and then injecting the bone cement (polymethyl methacrylate or PMMA) into the affected area by fluoroscopic guidance. As this cement hardens, it strengthens the bone giving immediate pain relief. This surgical procedure takes about an hours time and patient can leave the hospital with 24 to 48 hours. Most patients resume normal activity after a day or two.

Benefits of Vertebroplasty

• It solidifies the vertebral body
• It avoids the further degradation of the bones
• Crushing of the bones is avoided
• Stabilizes the back bone
• Normalizes the mobility of the person

Indications

Vertebroplasty would be indicated for diseases related with debilitating condition of the vertebral body, which may be with or without pain. These symptoms can be found in the following diseases.

• Osteoporotic vertebral fractures
• Vertebral hemangiomas
• Malignant vertebral tumors

Osteoporotic vertebral fractures

In this condition, spontaneous fractures are produced by minor imperceptible trauma. The treatment in these cases largely focuses on preventing the new fractures. The medicines which are administered in this condition avoid bone mass loss and stimulate bone formation. Thus the initial symptoms disappear in a few weeks.

However recurrent fractures are common in this and can cause serious morbidity. The long term consequences of vertebral fractures are height loss, kyfosis and chronic back pain.

Vertebral Hemangioma

These are benign vascular lesions of the vertebral body. They are asymptomatic but cause bone degradation and vertebral collapse. These result in back pain and neurological symptoms related with radicular nerve compression.

In radiological studies one can appreciate loss of fat tissue in the vertebral body (isodensity in CAT and Hypo or isodensity in T1 of MRI; with an active vascular component demonstrated by hyper density by CAT and hyper intensity in T1 of the MRI after EV contrast injection.

Vertebroplasty is indicated only in aggressive hemangiomas cases wherein the obtainable effects would be :

• Analgesic
• Medular radicular decompression
• Stabilization of back bones to avoid secondary deformities
• Control over the development of these vascular tumors

It was for these kinds of lesions that Vertebroplasty started in France. Vertebroplasty is complemented with percutaneus injection of ethanol or surgical cement, and is sometimes followed by laminectomy.

Malignant Vertebral Tumors

Malignant vertebral tumors like spinal metastasis, lymphomas and myelomas usually take place along with intense pain. Medical treatment like radiotherapy, quimio therapy, embolization and quimioembilozation could be used. But due to complications the success rate is low. The radithearpy for tumors does not prevent the compression fractures of the vertebral body but it alleviates pain in 70% of the cases within 2 to 6 weeks.

Vertebroplasty brings pain relief in most patients within first to third day after the procedure. Moreover it helps to obtain solidification of osteolytic lesion and improves column stability. Vertebroplasty is a soothing treatment with analgesic effect; however is not a cure for cancer or osteoporosis.

Factors Which Increase The Risk Of Vertebral Collapse

• Females are more prone to osteoporosis hence are at higher risk of vertebral collapse
• Risk of vertebral collapse is higher in older age people
• Family history of osteoporosis
• Post menopausal effects
• Abnormal absence of menstrual periods
• Anorexia or bulimia
• Low Calcium diet
• Chronic use of steroids
• Anticonvulsants
• Sedentary life style
• Smoking
• Alcoholism