INTENSE PAIN DUE TO VERTEBRAL FRACTURES CAN BE

EFFICIENTLY TREATED

Osteoporosis annually causes thousands of fractures in different parts of body every year. One of the most common places is the back. With a fall or physical strain one or more verterbra collapse causing vertabral (spinal) fractures.

A fall or physical strain can cause a compression fracture.

When a vertebral bone is fractured, the pain it produces is usually produces a severe pain that may even lead disability. Usually the first part of treatment is bed rest and pain killers, sometimes a corset is used. If this does not alleviate the pain, surgery may be needed. Several weeks of therapy will follow open surgery.

When several of the bones collapse, loss of height or stooped posture ("widow's hump") may occur. Usually, the fracture gets better by itself and the pain finally goes away. In many patients, however, the pain continues because the crushed bone continues to move and break.

Nowadays there is a procedure called VERTEBROPLASTY, which does not need general anesthesia or big skin cuts.  An Interventional radiologist inserts surgical cement inside the broken bone, using special X ray equipment for a highly precise procedure.

The procedure involves placing a small needle into the crushed bone. The bone cement is injected into the bone to secure it. Several crushed bones can be treated at the same time. Therefore, open surgery is not needed. The procedure takes about one hour and is usually done using only numbing medicine. Some patients who are in severe pain may need extra medicine to make them sleepy. Usually, patients can leave the hospital a few hours after the procedure is done.

This cement will harden and make a strong bone, alleviating or taking away the pain. The patient will be able to return to its daily activities, which he had to stop doing. The back bone is stabilized giving the patient security while walking.  

Many patients feel pain relief right away after vertebroplasty. Most report that their pain is gone or is much better within 48 hours. Most patients resume normal activity within 24 hours.
Vertebroplasty is very safe. The bone cement used to secure the broken bone is safe. Patients with tumors on the spine may be at slightly higher risk of complications.

Vertebroplasty is indicated for patients who have back bone fractures due to osteoporosis, for cancer patients and for hemangiomas.

                                               OSTEOPOROSIS

This disease develops in a silent way, manifesting itself only when the bones are already too weak. Simple sudden body movements, traction or small trauma lead to fractures.his disease develops in a silent
Osteoporosis is the loss of bone mass, usually in the elderly population. Fractures in patients with osteoporosis are more common in the back bones, where the bone is very weak, collapses or crushes.

Most patients think that he pain and disability caused by those fractures is permanent, because pain killers and bed rest do not alleviate pain.

For these patients with 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 the USA.

Vertebroplasty improves the patient’s mobility and flexibility, which restores his/her independence.  It consists of injecting a surgical cement called Polymethyl methacrylate (PMMA) or poly (methyl 2-methylpropenoate). It is injected inside the broken bone using a fluoroscopic guidance. This strengthens the vertebra and does not allow it to crush further, alleviating or disappearing the pain.

 25% of women and a slightly lower percentage of men with osteoporosis over 60 years of age in the USA, have vertebral fractures.

Vertebroplasty has the following benefits

I.   Solidifies the vertebral body.
II.   Avoids further crushing.
III.  Stabilizes the back bone.
IV.  Gives excellent analgesia.
V.   Normalizes mobility.

INDICATIONS

Therefore, Vertebroplasty would be indicated for any disease which debilitates the vertebral body with or without pain. We can find these characteristics in three well defined diseases:
1.- Osteoporotic vertebral fractures.
2.- Vertebral hemangiomas.
3.- Malignant vertebral tumors.

1.- Osteoporotic vertebral fractures

These are spontaneous fractures produced by minor imperceptible trauma. Medical treatment in these cases consists in preventing new fractures, drugs which will avoid bone mass loss and that stimulate bone formation. This way, initial symptoms usually disappear after 4 to 6 weeks.  
 
However, recurrent fractures are common and cause serious morbidity. Long time consequences of vertebral fractures are height loss, kyfosis and chronic back pain.

Lumbar vertebral fractures, treated with Vertebroplasty

2.- Vertebral Hemangioma

These are benign vascular lesions of the vertebral body. They are usually asymptomatic and rarely “aggressive”, manifesting rapid growth, bone destruction and vertebral collapse.  This produces 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.

• Analgesic
• medular radicular decompression
• back bone stabilization to avoid secondary deformities
• control the development of these vascular tumors.

It was with this kind of lesion that Vertebroplasty started in France.
Vertebroplasty is complemented with the percutaneous injection of ethanol or surgical cement, sometimes followed by laminectomy.

3- Malignant Vertebral Tumors

Malignant tumors of the vertebral column, like metastasis, lymphomas and myelomas usually take place with very intense pain. Medical treatment, radiotherapy, quimiotherapy, embolization and quimioembilozation could be used, but are not always successful or have complications.

Radiotherapy does not prevent a compression fracture of the vertebral body due to tumor necrosis and secondary column deformity. Moreover it alleviates pain in 70% of cases after 2 to 6 weeks.

Vertebroplasty alleviates pain in most patients within the first to third day after the procedure apart from obtaining the solidification of the osteolytic lesion and column stability.

Vertebroplasty is a palliative, much appreciated, treatment option and does not cure Osteoporosis or cancer.

61y/o, female patient, with Breast Cancer, with bone metastasis and cervical spine fracture with hard pain, resistant to all kind of medication. Next morning after Vertebroplasty, patient was asintomatic

RISK FACTORS FOR VERTEBRAL COLLAPSE

• Feminine sex
  
• Being thin
• Advanced age
• Family history of osteoporosis
• Post menopause
• Abnormal absence of menstrual periods
• Anorexia or bulimia
• Low Calcium diet
• Chronic use of steroids
• anticonvulsants
• no exercise
• Smoking
• Alcoholism