Osteoporosis and Vertebral Augmentation
Osteoporosis is a disease that gradually weakens bones and increases the risk for fractures. Osteoporosis and osteopenia (low bone density) affects an estimated 54 million Americans, according to the National Osteoporosis Foundation. Left untreated, osteoporosis can progress silently and painlessly. Often times the first sign of these problems is fracture of a bone.
Severe osteoporosis can cause fractures of the hip and wrist but can also cause compression fractures in the spine. This occurs when the spine bone, or vertebral body, collapses. This causes severe pain, deformity, and loss of height. It can also cause nerve compression. These fractures can be diagnosed with x-ray, CT scans, or MRIs. While osteoporosis is the most common cause, these fractures may also be caused by trauma or metastatic tumors.
Some people have a higher chance of getting the disease because of:
- Race: White and Asian women have the greatest risk.
- Age: The chances are higher for women over 50 and go up with age.
- Weight: Women under 127 pounds are at higher risk.
- Smokers: People who smoke lose bone thickness faster than nonsmokers.
- Gender: Women develop osteoporosis more often than men, although men do make up 20% of those with the condition.
Compression fractures occur in more than 750,000 patients per year in the United States, are more frequent than hip fractures, and often result in prolonged disability.
The symptoms of vertebral compression fractures may include any of the following, alone or in combination:
- Sudden onset of back pain
- An increase of pain intensity while standing or walking
- A decrease in pain intensity while lying on the back
- Limited spinal mobility
- Eventual height loss
- Eventual deformity and disability
Until recently, doctors were limited in how they could treat osteoporosis-related spine fractures. Pain medications, bed rest, bracing or invasive spinal surgery were the only options available. This meant that patients had to endure a great deal of pain while they simply waited for their fracture to potentially heal. Today there are promising therapeutic treatments for compression fractures. These procedures are called vertebral augmentation.
This is a minimally invasive procedure that can alleviate a large portion of the pain caused by compression fractures. It can also stabilize the fracture as well.
How is Vertebral Augmentation Performed?
This is typically performed under local anesthesia sometimes with a small amount of sedation. Using image guidance x-rays, a small incision is made and a probe is placed into the vertebral space where the fracture is located. The bone is drilled and a cavity is created for cement to be placed in. Sometimes a balloon is used to create the space and expand the bone. The spaces created by the drill are then filled with PMMA which is an orthopedic cement that binds the fracture. The cement hardens quickly, providing strength and stability to the vertebra, restoring height, and relieving pain.
After the procedure you are able to get back to your regular activities with minimal down time. Pain relief from this procedure occurs rapidly.
Benefits of Vertebral Augmentation
Limitations in the traditional treatments of vertebral compression fractures have led to the refinement of such procedures as vertebral augmentation. These procedures provide options for compression fractures and are designed to relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the “downward spiral” of untreated osteoporosis.
Additional benefits of these procedures include:
- Short surgical time
- Only sedation or local anesthesia required
- No hospital stay
- Patients can quickly return to the normal activities of daily living
- No bracing required
Complication rates for vertebral augmentation have been estimated at less than 2 percent for osteoporotic fractures.
Screening for osteoporosis is very important. Bone density scans are typically covered by insurance and are important for detecting and monitoring osteoporosis. Be sure to ask your primary care physician about this important screening tool!
by Dr. Jessica Jameson, Axis Spine Center
Dr. Jameson received her medical degree from Michigan State University and completed her internship at David Grant USAF Medical Center, Travis Air Force Base, California. After spending four years as a United States Air Force Flight Surgeon, Dr. Jameson completed her residency in Anesthesia at University of Iowa College of Medicine, Iowa City. She continued her education with a Harvard fellowship in Pain Medicine at Beth Israel Deaconess Medical Center, Boston, MA and became board certified in both anesthesiology and pain management by the American Board of Anesthesiology.