WHAT IS OSTEOPOROSIS?
Osteoporosis is a condition in which bones become thin and fragile. It is called a “silent disease” because bone loss occurs without symptoms. People may not know that they have osteoporosis until their bones become so weak that a simple strain, twist of the body, bump or fall causes a bone fracture. Fractures may occur in the hip, wrist, ribs or elsewhere, but one of the more common sites of fractures is in the vertebrae, the bones that make up the spinal column.
HOW COMMON ARE SPINAL FRACTIONS CAUSED BY OSTEOPOROSIS?
Twenty eight million Americans have thinning bones and are threatened by the disease. Of these 28 million, 10 million people in the U.S. suffer from osteoporosis. Eighty percent of those who are at risk and affected by the disease are women. Osteoporosis causes more than 1.5 million fractures a year, of which 700,000 are spinal (vertebral) fractures. Most of these cause pain.
WHO IS AT RISK?
Factors that increase the likelihood of developing osteoporosis include:
- Being female
- Being thin or having a small frame
- Advanced age
- A family history of osteoporosis
- Being post menopause
- Abnormal absence of menstrual periods
- Anorexia or bulimia
- A diet low in calcium
- Long-term use of medications such as corticosteroids or anticonvulsants
- Lack of exercise
- Smoking
- Excessive use of alcohol
HOW ARE SPINAL FRACTURES TREATED?
Fractures of the vertebrae have traditionally been much more difficult to manage than broken bones in the hip, wrist or elsewhere that often can be treated successfully with surgery. Surgery on the spine has not typically been used to treat vertebral fractures associated with osteoporosis, except as a last resort. Until recently, reduced activity and pain medications, many of which cause side effects, or back surgery were the only treatments available. These treatments can be effective in up to 90 percent of patients but may require several weeks of therapy.
WHAT IS VERTEBROPLASTY?
In the procedure, a needle is inserted through the skin and into the crushed vertebrae. A special bone cement used for medical purposes (called poly-methylmethacrylate) is injected into the bone to stabilize it. Often, more than one crushed vertebrae can be treated in a single procedure. Open surgery is not required because the interventional/neurointerventional radiologist is able to guide the needle to the spot using special X-ray equipment.
Vertebroplasty takes from one to two hours to perform, depending on how many bones are treated. The procedure may be performed with mild sedation and local anesthesia that numbs the treated area, or the patient may be given general anesthesia.
Some patients experience immediate pain relief after vertebroplasty. Most report that their pain is gone or significantly better within 48 hours. Many people can resume normal daily activities within hours to days after treatment.
WHAT ARE THE RISKS OR COMPLICATIONS?
Vertebroplasty is a very safe procedure with few risks. Complications are rare and should be discussed with your doctor. As with any medical procedure, the possibility of complications will depend on the individual patient. For example, patients with tumors in the spine or with other serious medical conditions may be at higher risk for complications from vertebroplasty.
WHO IS A CANDIDATE FOR VERTEBROPLASTY?
People who have suffered recent fractures that are causing moderate to severe back pain despite standard therapy with rest and pain medications, are the best candidates for vertebroplasty. Older fractures may be treated, but the procedure is most successful if it is performed within one year of when the fracture occurs. Chronically painful fractures causing pain for months to years are also very frequently treated with excellent results. The procedure is not used to treat arthritis or herniated disks.
WHAT IS AN INTERVENTIONAL/NEUROINTERVENTIONAL RADIOLOGIST?
Interventional and neurointerventional radiologists are physicians who have special training to diagnose and treat conditions using miniaturized tools while watching their progress on X-ray or other imaging equipment. Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip. Interventional radiology treatments are generally easier for patients than surgery because they involve no surgical incision, less pain and shorter hospital stays. Your interventional/neurointerventional radiologist will work closely with your primary care physician to be sure you receive the best possible care.
This information is provided by the Society of Interventional Radiology © 2004,www.SIRweb.org. All rights reserved.