DOCTOR'S VIEW ARCHIVE
Medical Author: William C. Shiel, Jr., MD, FACP, FACR
Because broken bones due to osteoporosis, the progressive loss of bone tissue, are very common and may be very painful, a new way of treating these fractures called vertebroplasty is real medical news.
Normal bone is composed of a framework made of a particular protein, collagen, and calcium salts. Osteoporosis depletes both the collagen and the calcium salts from the bone. The bone then becomes weaker and more prone to breaks (fractures), either by cracking or by collapsing (compression).
Patients with osteoporosis generally have no symptoms until the bone fractures begin. Fractures of the bony building blocks (vertebrae) of the spine are usually a result of the compression of bone. This leads to collapse of the vertebrae much like a sponge collapsing under the pressure of one's hand. A fracture that collapses a vertebra in this way is referred to as a vertebral compression fracture.
Spinal vertebral fractures can occur without pain. However, they often cause a severe "band-like" pain that radiates from the spine around both sides of the body. Over many years, the spinal fractures cause a loss of height of the spine resulting in the person becoming shorter. A curvature of the spine can also occur giving the individual a hunched-back appearance (the so-called dowager's hump). This can lead to chronic backaches.
The treatment of vertebral compression fractures has been limited to taking pain medicine, resting, avoiding injury, and bracing.
A unique procedure to treat new vertebral compression fractures, first developed in France, was pioneered in the United States by Dr. Mary E. Jensen at the University of Virginia. The technique is called vertebroplasty and is performed by a radiologist without surgery.
Vertebroplasty involves inserting a glue-like material into the center of the collapsed spinal vertebra in order to stabilize and strengthen the crushed bone. The glue (methylmethacrylate) is inserted with a needle and syringe through anesthetized skin into the midportion of the vertebra under the guidance of specialized x-ray equipment. Once inserted, the glue soon hardens, forming a cast-like structure with the locally broken bone.
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At a conference in Irvine, California (1998), Dr. Jensen said that relief of pain may come from a "cast-like" effect of the hardened glue on the broken bone. The newly hardened vertebra may then be protected from further collapse.
Vertebroplasty can relieve pain extremely fast, even within a day in some patients! Dr. Jensen described patients being released from requiring intravenous pain drugs.
The advantages of vertebroplasty, aside from prompt pain relief, include better mobility. (Often patients with new vertebral fractures can't even sit up without worsening the severe pain and the inactivity contributes to further osteoporosis).
Dr. Jensen was asked if severely collapsed vertebrae wouldn't be technically more difficult as well as less successful to treat. She indicated that vertebrae that have collapsed to less than 30% of their normal height were indeed poor candidates for this procedure because of poor success rates.
She did point out her successful treatment of more than one vertebral compression fracture in the same patient!
Vertebroplasty appears to be an exciting option for urgent control of pain from vertebral compression fracture. While only just being introduced in the United States, it will likely become more widely used as radiologists gain experience in the procedure.
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