Osteoporosis is a disease that results in a loss of normal bone density, mass and strength, leading to a condition in which bones are increasingly porous or full or small holes and vulnerable to breaking. When a vertebra fractures, the usual rectangular shape of the bone becomes compressed and distorted, causing pain. These compression fractures, which may involve the collapse of one or more vertebrae in the spine, are a common symptom (it affects about 1.4 million people worldwide) and result of osteoporosis.
But when the pain becomes unbearable for those suffering from spinal bone fractures due to osteoporosis, there are generally two options: bed rest (often combined with a protective brace and painkillers) or a controversial procedure known as a vertebroplasty.
Vertebroplasty is a minimally invasive procedure for vertebral compression fractures (VCF), which are fractures in vertebra, the small bones that make up the spinal column. Typically, vertebroplasty is recommended after simpler treatment, such as bed rest, a back brace or pain medication, have been ineffective, or once medications have begun to cause other health problems.
In a vertebroplasty, a surgeon uses a hollow-point needle to inject a cementlike substance, typically poly (methyl methacrylate), or PMMA, into any cracks or fractures found in the spine. The surgeon will also use a fluoroscope, which includes an X-ray device and a fluorescent screen, to monitor the needle’s location inside the body and ensure that the sealant is injected into the proper location.
However, this procedure has some risks:
- Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
- A small amount of orthopedic cement can leak out of the vertebral body. This does not usually cause a serious problem, unless the leakage moves into a potentially dangerous location such as the spinal canal.
- Other possible complications include infection, bleeding, increased back pain and neurological symptoms such as numbness or tingling. Paralysis is extremely rare.
- There is a risk of allergic reaction to the contrast material used for intraosseous venography or to help visualize the balloon as it inflates on the x-ray image.
But there are doctors who support the procedure despite its risks. In fact, two studies published last month in The New England Journal of Medicine (NEJM ) sustain that participants in a study who received vertebroplasty felt no less pain than participants who were given a placebo treatment, in which no bone cement was injected into the spine.
According to these studies, the vertebroplasty has the following benefits:
- Vertebroplasty can increase a patient’s functional abilities, allow a return to the previous level of activity without any form of physical therapy or rehabilitation and prevent further vertebral collapse.
- The procedure is usually successful at alleviating the pain caused by a vertebral compression fracture; many patients feel significant relief almost immediately. Many patients become symptom-free.
- Following vertebroplasty, about 75 percent of patients regain lost mobility and become more active, which helps combat osteoporosis. After the procedure, patients who had been immobile can get out of bed, reducing their risk of pneumonia. Increased activity builds more muscle strength, further encouraging mobility.
- Usually, vertebroplasty is safe and effective.
- No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.
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