Osteoporosis, which strikes many women after menopause, often makes sufferers lose an inch or so off their height and results in a slightly stooped posture. Most women – and some men – can live with that, thinking it’s part of the normal aging process, but the disease, a thinning of the bones, can also lead to spinal compression fractures which often cause debilitating pain.
When spinal compression fractures are diagnosed with the help of X-rays, it means that some bones in the vertebrae have collapsed. Softened bones due to osteoporosis have allowed normal everyday activity (bending, reaching, even sneezing) to result in these fractures, which can cause sharp pains in the lower back.
The most conservative course of treatment consists of over-the-counter pain medication, and a back brace designed to act much like a cast does on a broken bone. This approach works much of the time on compression fractures. However, if the pain is no better after a few months of non-invasive treatment, it may be time for a more aggressive approach.
Fortunately, sufferers can now benefit from a number of other treatment options. One of those options is vertebroplasty, a procedure which has been performed in the United States since the 1990s.
It is a minimally invasive procedure that is done on an outpatient basis and is specifically designed for stabilizing compression fractures. It is performed while the patient is under conscious sedation, just like for colonoscopy patients, rather than general anesthesia. It’s also a procedure which now has a considerable history of sucess in the United States, having been introduced in the 1990s.
A neuroradiologist or interventional radiologist will pass a hollow needle into the vertebral body; imaging technology is used as a guide. A medical-grade cement will be injected; the injection will contain antibiotics to help prevent infection. The cement will harden quickly, usually within 15 minutes. The entire procedure, including rest in the clinic where it takes place, will take about a half-day.
The medical grade cement immobilizes the micro-fractures and relieves the patient’s pain, much like a cast does for a broken bone.
Dr. Paul Hatten of Indian River Radiology, himself a neuroradiologist, has performed about a thousand vertebroplasties in the last decade or so.
Dr. Hatten says these procedures are typically done on an outpatient basis, with the patient in by 8 a.m. and out by noon. Rather than general anesthesia, “conscious sedation” is used. Post-procedure, some patients experience discomfort at the injection site and residual wooziness from the medication.
There is a profile of people who are risk for osteoporosis. According to a paper published in 2004 by the Society of Interventional Radiology (www.sriweb.org) risk factors include:
• Of Caucasian or Asian race
• Thin, petite body type
• Family history
• Early menopause
• Lactose intolerance
• Smoking
• Excess use of caffeine or alcohol
• Estrogen deficiency
• Sedentary lifestyle
Also, being female is a risk factor in and of itself; one in 3 women over age 50 will be diagnosed with osteoporosis, compared to only 1 in 5 men.
This profile is reflected in Dr. Hatten’s patients, up to three-quarters of whom he says are post-menopausal Caucasian women.
For those with osteoporosis, everyday activity (bending, reaching, and even sneezing) can result in compression fractures. At first, there may be no symptoms, but as time passes back pain is often felt (usually in the middle or lower spine). The pain is worse when walking and is not present when resting. Over time, loss of height and the stooped posture called the “dowager’s hump” can also result.
Compression fractures are diagnosed through a physical exam and some sort of imaging test—most typically an X-ray; sometimes an MRI or a CT scan. Non-invasive treatments are usually tried first; including analgesic pain medications, back braces, and bed rest (although long periods of inactivity can actually worsen the condition).
Patients who turn to surgical options have a few to choose from:
• Vertebroplasty, as described above.
• Kyphoplasty, similar to vertebroplasty, but a balloon is first injected into the spine and inflated, followed by the cement.
• Spinal fusion, in which two or more vertebrae are connected by metal hardware. Highly invasive, this is seen as a last resort.
Additional information can be found at the National Osteoporosis Foundation (www.nof.org) and government web sites such as the National Library of Medicine at the National Institutes of Health (www.nlm.nih.gov).
