By Alexander Germanis
Potholes. Unfortunately, they are a familiar sight — and feeling — this time of year. Streets everywhere have been subjected to the flux of thawing and freezing combined with the added weight of constant traffic. This results in broken, shattered and pitted roads that are unfit to support those who use them — roads that can be uncomfortable and even painful to utilize.
Osteoporotic fractures of the spine cause the same problems for those hundreds of thousands of people per year who suffer from them. The breaks cause pain and the pain causes immobility, which, as discussed in last month’s article, can lead to a host of other severe medical issues. Fortunately, those spinal fractures, like the potholes in the road — are fixable.
Dr. Ramsin Benyamin of the Millennium Pain Center is an expert in treating pain and therefore understands the importance of treating the cause of that pain, not just the symptoms. “The reason they have pain is because of movement of loose pieces of bone. The bone has collapsed and is unstable,” he explains. “Therefore, movements, even breathing deeply, will cause pain. So the treatment is based on stabilizing the fracture. Bringing those loose pieces together and preventing them from moving — that’s the essence and goal of the treatment.”
Stabilizing a bone is something that is usually done with either a plaster cast or through the use of surgical fixtures like pins or screws, but one of the many difficulties in treating vertebrae is their location in the anatomy. “We can’t put a cast around your body,” Dr. Benyamin aptly points out. “So, we inject the cast inside the bone so the pieces of bone don’t move anymore. The ‘cast’ is bone cement.”
Like adding asphalt or fresh concrete to a pothole, the bone cement fills the voids created by the breaks in the vertebra, bonding them into a new, cohesive whole.
“There are usually two groups of treatment,” Dr. Benyamin explains. Vertebroplasty and vertebral augmentation. Neither procedure requires an incision to be made. Instead, both are performed percutaneously, that is they are performed through the skin.
In vertebroplasty, a needle is put through the skin of the back near the affected site. By using fluoroscopy, or a live x-ray feed, the doctor is able to guide the needle to the appropriate vertebra and, as Dr. Benyamin succinctly puts it, “places the needle in the bone and injects the bone cement.”
“The second group of procedures,” he continues, “is vertebral augmentation.” One of the common types is also known as Kyphoplasty™, from the Greek word meaning ‘hump formation.’ It “involves placing the needle in the bone and then creating a void or cavity and filling that space with bone cement. That space is sometimes created by inflation of a balloon and sometimes by an instrument that creates a cavity inside the bone.”
The purpose for creating the cavity is two-fold: it stabilizes the vertebra for the procedure, and it may restore the height of the vertebra prior to the injection of bone cement.
Because both are performed percutaneously, “they are done as outpatient procedures,” Dr. Benyamin says. There is “no incision, no general anesthesia.” Only a local anesthetic and minimal sedation is administered.
“When the treatment is minimally invasive, there’s no surgery,” the doctor sums up simply. “The procedure takes half an hour. They get up and leave because the cement hardens within 20 minutes.”
Dr. Benyamin cannot stress enough that getting a patient mobile again as quickly as possible is paramount. “We need to be vigilant and treat these patients. We need to treat them so they can get up and going again so they don’t lie in bed suffering,” he says. The dangers of immobility due to vertebral fracture are the same as those presented by immobility after fixing that vertebral fracture: muscle atrophy, loss of lung function, risk of blood clots, and so on.
Just as a road full of potholes needs to be mended in order to not crumble into complete disrepair, and subsequent disuse, the faster it is mended and reopened, the better it is for those who require it. So it is for our bodies on the move. The body is not a static fixture. It needs to stay active and mobile in order to maintain a healthy existence.
If you missed the first article, “Osteoporotic Fracture of the Spine,” you may read it online www.HealthyCellsBN.com or contact Cheryl Eash, 309-664-2524 ceash7@gmail.com.
Millennium Pain Center, located at 1015 S. Mercer Ave. in Bloomington, provides the most advanced and comprehensive pain management for a wide variety of conditions. For more information, you may contact them at 309-662-4321 or online at www.millenniumpaincenter.com.
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