Osteoporosis as a problem is commonly seen in Post menopausal Women. Bones especially cancellous bones become very brittle and are prone to fractures.
Spinal fracture also called vertebral compression fracture occurs most often in the thoracic or middle spine. Most common cause is trivial fall at home and in some cases sudden jerk or violent coughing and sneezing. Compression fractures cause mild to severe pain depending on severity of fracture, which increases with activity and gets better with rest. In majority of cases there is no neurological deficit but some cases develop weakness in legs when fracture fragment starts compressing the spinal Cord.
Diagnosis is usually made on Clinical Examination and Xrays. MRI is not indicated in all cases but should be done to rule out pathological fractures due to metastasis or infection especially in patients with long standing pain, constitutional symptoms and advanced age.
Treatment for osteoporotic fractures is initially conservative. It includes pain medication, rest and bracing. Medication simply relieves the pain but bracing will restrict movement, relieve pressure and allow the fracture to heal. Majority of fractures heal with some kyphosis with nonoperative managent. Patients are mobilised out of bed with brace as soon as pain permits. most of the fractures unite within 2-3 months but some fracture go into non union and these patients have persistent back pain restricting activities. These patients then require cement augmentation procedures like vertebroplaty or ballon kyphoplsty
Kphoplasty
Kyphoplasty uses a two-step process of inserting of a special balloon device into the compacted vertebrae to attempt to restore the vertebrae to a more normal shape. Subsequently, a cement-like material (polymethylmethacrylate) is injected into the space created by the balloon to retain the correction. By restoring the vertebrae to a more normal state, alignment of the spine is improved. Kyphoplasty is performed through a small incision in the back. It is done in a hospital setting under either a local or general anesthetic, depending upon the severity of the case and fitness of the patient. The cement mixture hardens in about half an hour. Pain killers are often given to the patient for the first couple of days to help ease the pain The entire procedure takes about an hour and patients may return home the day of surgery, or perhaps stay in the hospital overnight. Pain relief may be seen within two days of surgery.
Kyphoplasty may be preferred to open surgery for osteoporosis patients because of the already brittle bone. However, this procedure will not correct the bone lost due to by osteoporosis; it may only stabilize new fractures. The procedure may restore lost height and decrease “widow’s hump.”. Patients who have one vertebral fracture are five times more likely to get another adjacent to the damaged one; therefore steps should be taken to limit the effects of osteoporosis. Although complications appear to be less than 1%, Kyphoplasty can cause infection, bleeding or embolism if the cement mixture gets into the blood stream and passes through the heart and lungs
Case
Osteoporotic vertebral compression fractures and cement augmentation or kyphoplasty
78 yr old male had fall in bathroom resulting in L3 lumbar vertebra fracture. Pt was diabetic and hypertensive. Fracture was intially managed nonoperatively with rest, belt and medicines. Howe3back pain persisted and pt was bedridden. His MRI showed nonunion of L3 fracture. Due to severity of pain and ununited fracture a decision to do cement augumentation by kyphoplasty.
The surgery was performed as day care procedure under local anaesthesia. Pt was made to sit in evening and discharged. He reported significant improvements in pain and activities.
Dr Pramod Saini is Consultant spine surgeon associated with Jaypee Hospital, Noida. He is an Orthopaeidic surgeon with a special training in spine surgery. His area of expertise is Minimally Invasive Spine Surgery. He specializes in Management of Slip disc, Sciatica, back pain and all spinal problems.
