Osteoporotic Spinal Fractures
Osteoporosis, also known as bone loss, is a disease increasing fracturing possibility of the bone due to decrease in the calcium contained in the bone structure. According to data of The Turkish Osteoporosis Society, it is seen in one out of three women above age of 50 (more than breast cancer) and in one out of 5 men (more than prostate cancer). On the other hand, it is known that this disease causes 1.5 million fractures in United States of America every year.
What are the symptoms of Osteoporosis?
The most common symptom of osteoporosis is the pain in the spine and back. Reason of this pain is explained as micro fractures observed in the weak bone. Bones have many fractures in microscopic level. These fractures are repaired with bone tissue produced by the body. However, this process inhibits in osteoporosis. In that case, micro fractures grow and cause bigger fractures. Symptoms of osteoporosis include low back pain and back pain, decrease in length, kyphosis with sensitive fracture. If kyphosis gets severe, compression on the spine develops and causes numbness in legs, tingling, weakness, urinary incontinence, inability in walking.
What are the methods to prevent osteoporosis?
If the bone with osteoporosis is supported by the muscles, even if the patient is old or with osteoporosis, s/he can minimize the risk of fracture by exercising regularly and strengthening the muscles of low back. A bone needs a healthy muscle tissue and nervous system which protect and move the bone to enable the bone to resist the fractures. In addition, bone reservoirs need to be filled with calcium. Therefore, Vitamin D is very important. The biggest source of Vitamin D is the sun. It should be paid attention to consume foods such as white cheese, milk and yogurt and sports should be maintained to store the calcium. Osteoporosis-dependent spinal fractures Osteoporosis is the most common of compression fractures seen in the spine. Generally, it is seen in more than one vertebra. When fracture occurs as a result of osteoporosis, generally vertebrae in the thoracal or low back area are affected. In early stages, a fracture in the bone may worsen without any symptom. Pain or other symptoms may get worse with walking and generally they are not present during rest. Multiple fractures may cause kyphosis, roundness of the spine. In patient with osteoporosis, spinal fractures may occur without any impact, while they may be caused by mild impacts which do not harm the spine under normal conditions or inverted movements.
Traditional treatment of the osteoporosis-dependent compression fractures was bed rest for about 3-4 months until the patient recovers or use of corset produced with metal or rigid plastic which prevent load on the spine. Today, in the treatment of osteoporosis-dependent spinal fractures, very successful results are obtained with vertebroplasty and kyphoplasty method applied in our country in recent years.
Percutaneous vertebroplasty and kyphoplasty application are the methods gaining popularity in the painful spinal compression fractures. In a multi center study carried out with 245 patients applied percutaneous vertebroplasty in USA, the patients were asked to state the pain they felt out of 10, and it has been revealed that pain scores of the patients decreased to 3.4 from 8.9 after vertebroplasty. In the same study, it has been observed that the rate of the patient for returning to daily activities without pain increased to 62% from 9%.
Vertebroplasty and kyphoplasty procedure is applied for benign tumors, cysts and metastasis located in the spine and weakening the spine body in addition to osteoporotic spinal fractures. In suspicious fractures, it is possible to make diagnosis by taking biopsy from the fractured vertebra body during intervention.
It is applied in many centers in our country. The procedure is carried out under local anesthesia and operating room conditions. The procedure is carried out with two 0.5 cm incisions depending on the technique. Special-produced bone needles are placed into fractured vertebra structure. Afterwards, the bone is strengthened bu injecting polymethylmethacrylate cement called bone cement. When the cement is injected into the bone, it has paste stiffness, however when it is injected, it gets hard within 10 minutes and takes a bone-similar shape. In recent years, it has been started to inject cement as preservative to prevent fracture in the weak vertebrae without fracture.
Just like as vertebroplasty, kyphoplasty is a method used in the treatment of painful compression fractures in osteoporotic spine. Unlike vertebroplasty, firstly a balloon is inflated in the fractured vertebra and height is regained. Afterwards, bone cement is injected. It is possible to eliminate the pain of the patient with compression fractures by 90% with kyphoplasty. With kyphoplasty, pain is stopped and the fracture is stabilized, then compressed vertebra regains height and kyphosis is corrected. It can be carried out under local anesthesia in operating room like vertebroplasty. Application of vertebroplasty or kyphoplasty in the patient with osteoporotic compression fracture is determined according to the compression amount in the spine and the deformity of the spine. The patients are risen after 4-5 hours without any corset or exterior support. Patients are hospitalized for 24 hours for follow-up, then discharged. As other procedures, vertebroplasty or kyphoplasty contain some risks; these risks may appear depending on the general health status of the patient, in case of general anesthesia, on anesthesia and performed surgical procedure. Risk caused by general health problems of the patient are minimized by carrying out the procedure under local anesthesia.