SPINE PROCEDURES

Vertebroplasty: New Treatment for Vertebral Fractures
Procedure to treat complications of Osteoporosis introduced
to Long Island
By Laurence E. Mermelstein, M.D.

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Osteoporosis is a potentially debilitating condition that affects millions of people in this country. A significant amount of interest has been seen recently in the diagnosis, prevention and treatment of the bone loss seen with this condition. The advent of bone densiometry screening and the introduction of newer, more effective drugs to treat osteoporosis will significantly decrease the morbidity associated with this condition.

Osteoporosis, in its earliest stages, is a silent disease without any signs or symptoms. Unfortunately, many patients' first sign of this disease is a painful fracture. Common sites of fracture are the wrist, hip, ribs and vertebra (spine). These fractures may occur with little or no direct trauma and result in painful fractures requiring immobilization and/or surgery. Vertebral compression fractures (VCF's) are the most common fracture associated with osteoporosis, responsible for approximately 700,000 fractures annually.

Until recently, there was very little that could be done for osteoporotic vertebral fractures. These fractures can cause severe back pain requiring the use of narcotic pain medications and prolonged hospital stays. These VCF's frequently go on to heal in a collapsed position resulting in loss of height and "Dowagers hump" (kyphosis) deformity. This resultant deformity predisposes the remaining spine to subsequent VCF'S. Multiple fractures lead to worsening deformity and decreased activity. The decreased activity can lead to accelerated bone loss and further increase fracture risk. Increasing deformity can eventually cause pulmonary dysfunction and contribute to an overall 30% increase in mortality.

In order to prevent this downward spiral, early intervention is required. Many orthopedic surgeons now believe that these fractures require similar treatment to osteoporotic hip fractures: rapid stabilization, internal fixation and early mobilization. New, minimally invasive surgical technology has been applied to the treatment of VCF'S, allowing these fractures to be internally stabilized and the patient rapidly mobilized. Vertebroplasty, as this procedure has been termed, is an FDA approved procedure, which is beginning to change the way thousands of patients with newly diagnosed VCF's are treated.

The vertebroplasty procedure involves a minimal incision technique, whereby one or two punctures are made in the back over each involved vertebra. The procedures are performed in a hospital operating room under a local anesthetic with intravenous sedation. A one-day hospital stay is required for observation. A balloon is inserted through the small punctures and navigated into the vertebra using x-ray guidance. Similar to an angioplasty procedure, the balloon is then inflated, thereby reducing the fracture. The resulting gap in the vertebral bone is then supplemented with a synthetic filler (usually acrylic cement).

The post-operative recovery is usually rapid; patients are ambulatory within hours of the procedure and are discharged in under 24 hours. Patients usually have significant reduction in their fracture pain and minimal post-operative discomfort. No post-operative bracing is required. Aggressive medical management and/or work-up for osteoporosis is begun, if not addressed before the procedure.

Patient feedback from these procedures has been remarkably positive. Instead of a traditional long, prolonged, painful recovery from a vertebral fracture, these patients have experienced a more rapid return to activity. Patients begin an early rehabilitation program which we know is of critical importance for overall well-being. Persons with or without a known history of osteoporosis who experience the sudden onset of back pain, even without significant trauma, need to be evaluated in a timely fashion. If an acute fracture is diagnosed, they may be candidates for this new technology.

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