Managing and preventing spine fractures
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Vertebroplasty treatment example
An 83-year-old woman, with severe osteoporosis, developed sudden severe mid back pain that radiated to the front of the chest on both sides. This occurred when she bent over to pick up an object. The pain was constant and worse when she tried to get up from a lying position. A primary care doctor initially examined her. Pain medications were given, but resulted in little pain relief. Additional imaging workup, including plain films and a CT scan, revealed an osteoporotic compression fracture of the T8 vertebra, which was consistent with the patient’s pain distribution and pattern.
Vertebroplasty was seen as the best treatment for pain relief and improved quality of life. Several days after the diagnosis, the vertebroplasty procedure was performed. The patient described the pain relief as “instantaneous”, and she was able to return to her normal daily routine.
However, approximately two weeks later, the pain returned but in a location that was slightly higher than the previous pain. X-rays revealed a new compression fracture at the T7 vertebra. This new fracture most likely occurred as a result of the patient’s underlying osteoporosis. Vertebroplasty was successfully performed on this new fracture as well. Pain relief was immediate and the once bed-ridden patient who had trouble standing upright returned to her normal activities of golf, walking and socializing with friends.
At the time of this writing, which is one year after treatment, the patient continues to do well with no additional fractures.
Preventing future vertebral compression fractures
This patient’s second fracture points to the need for patients with osteoporosis to aggressively treat the disease with medication and other means to avoid additional osteoporotic compression fractures. Vertebroplasty does not prevent additional fractures.
Eating foods rich in calcium and vitamin D and participating in weight-bearing exercises, such as walking, dancing and weight-lifting, can help slow the process of osteoporosis by keeping bones healthy. Calcium supplements, osteoporosis medications, and hormone replacement therapy for post-menopausal women may also be recommended. It is also important for patients to reduce their risks of falling by making their homes safer (e.g., install grab bars in the bathroom, get rid of small rugs) and their overall mobility safer (e.g., wear non-slip shoes).
A bone mineral density (BMD) test is used to diagnose osteoporosis and determine a patient’s risk for future fractures. A bone density test is recommended for all women over the age of 65 and postmenopausal women younger than 65 who have other risk factors for osteoporosis, such as experiencing a bone break after age 50, are thin and small-boned, lead an inactive lifestyle, or have a family history of osteoporosis. Women who have had a hysterectomy are also at increased risk.
If a vertebral compression fracture is suspected, the physician will do a complete patient history, physical exam (including testing for tenderness along the spine) and an x-ray. Additional diagnostic testing may be ordered to confirm the diagnosis, such as a CAT scan and/or MRI scan. A nuclear bone scan may be ordered to help determine the age of the fracture, which helps guide appropriate treatment options. In addition to diagnosing the fracture, the physician will also need to diagnose the cause of the fracture. While osteoporosis is the most common cause of vertebral compression fractures, some kind of trauma to the spinal vertebrae or cancer can also cause spinal fractures.
It is advisable to consult with a physician if anyone has severe or continuous back pain, suspects osteoporosis, or believes they have suffered a spine fracture.
References
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National Osteoporosis Foundation fast facts page. National Osteoporosis Foundation Web site. Available at http://www.nof.org/osteoporosis/diseasefacts.htm. Accessed March 21, 2005.
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Do HM. Percutaneous vertebroplasty. Dis Manage Dig. 2004;8:2-4.
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Centers for Medicare and Medicaid Services, United States Department of Health & Human Services available at http://www.cms.hhs.gov/paymentsystems/icd9/icd040104.pdf. Accessed May 10, 2005.
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Agris J, Hussain N, Gailloud P, Murphy K. Meta-analysis comparing the in vivo cement extravasation rates for vertebroplasty and kyphoplasty. Paper presented at the American Society of Spine Radiology; February 15-19, 2004; Miami, Fla.
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North American Spine Society. Percutaneous vertebral augmentation. Available at http://www.spine.org/articles/NT_Percu_Vert_Aug.cfm. Accessed May 10, 2005.
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Diamond TH, Champion B, Clark WA. Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med. 2003;114:257-265.
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McGraw JK, Lippert JA, Minkus KD, Rami PM, Davis TM, Budzik RF. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol. 2002;13:883-886.
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Zoarski GH, Snow P, Olan WJ, et al. Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol. 2002;13:139-148.
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Legroux-Gerot I, Lormeau C, Boutry N, Cotten A, Duquesnoy B, Cortet B. Long-term follow-up of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Clin Rheumatol. 2004;23:310-317.
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Evans AJ, Jensen ME, Kip KE, et al. Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty—retrospective report of 245 cases. Radiology. 2003;226:366-372.
- Do HM, Kim BS, Marcellus ML, Curtis L, Marks MP. Prospective analysis of clinical outcomes after percutaneous vertebroplasty for painful osteoporotic vertebral body fractures. AJNR. 2005;26:1623-1628.
