Putting Cement in a Broken Bone
May 02, 2016
By Craig Carmichael, MD, McLean County Orthopedics
Doctor, my mom fell six weeks ago, and her pain has been excruciating. She moved into a nursing home because she cannot walk, and she is deteriorating rapidly,” describes the family of a patient with a spinal compression fracture. The good news? This patient was treated with a simple outpatient procedure, left the nursing home a few days later, and has been able to live at home independently without pain. What is this procedure? Percutaneous vertebral augmentation, which is a fancy way of saying “putting cement into a broken bone using a needle.”
Nearly 50 percent of women and 25 percent of men will have a spinal compression fracture in their lifetime, although they are not always painful. Spinal fractures are generally caused by osteoporosis, and it takes a surprisingly small injury to cause the fracture—often just opening a stuck window or stumbling getting out of bed. Postmenopausal women are at highest risk. Most (about two-thirds) of spinal compression fractures are never diagnosed because the pain is dismissed as arthritis. Therefore, it is important to consider the possibility of fracture in anyone over 50 with sudden onset back pain. The pain tends to be constant and severe, but it is worse with standing, walking, or other physical activity.
Vertebral compression fractures cause other problems (see sidebar). The severely reduced mobility and physical activity cause muscle wasting as well as respiratory, bowel, circulatory, and skin problems. Early aggressive treatment with vertebral augmentation might help prevent these complications.
People can prevent vertebral compression fractures, hip fractures, and other fractures by preventing osteoporosis. It is critical that young people have adequate calcium intake (milk or calcium pills) before the age of 25. Strangely, the body cannot add to bone mass beyond the age of 25. If osteoporosis is detected early enough, then medications can slow the progression of osteoporosis and prevent fracture. Perimenopausal women, adults treated with chronic prednisone, patients with hormonal abnormalities, and others who are at increased risk for osteoporosis should be screened with a bone mineral density study (BMD), which is an easy and painless test for osteoporosis.
Once a vertebral fracture has occurred, treatment is often initiated with strong pain medication; relative rest, though not complete bed rest; and a back brace. If the pain continues to be severe, the most effective treatment is vertebral augmentation, which can be done in a surgery center, doctor’s office, or hospital and does not require an overnight stay. The patient is given light sedation through an IV, the skin and deeper tissues are anesthetized with lidocaine, a tiny incision is made with a scalpel, and a needle is directed down to the bone with X-ray guidance. The needle can be pushed into the bone almost painlessly with proper use of anesthetic. Inside the bone, a small cavity can be made. A special type of “cement” is injected through the needle into the cavity. This has the result of rapid improvement in pain as well as increased stability of the bone.
Recovery is rapid. Most patients feel dramatically better by the time they leave the surgery center. Patients should avoid strenuous activity for a few days but can return to normal daily activities immediately. Medication treatment should be considered to prevent further fractures. A 2010 study published in The Lancet, a medical journal, concluded that, “Pain relief after vertebroplasty is immediate, is sustained for at least a year, and is significantly greater than that achieved with conservative treatment, at an acceptable cost.”
For more information, you may contact Dr. Carmichael at McLean County Orthopedics, 309-663-6461 or www.mcleancountyorthopedics.com. The practice treats all types of orthopedic conditions and offers a comprehensive range of services. Dr. Carmichael trained at Mayo Clinic and treats back and neck problems. The office is located at 2502 E. Empire in Bloomington.
Sources upon request
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