July 17, 2007
Leading treatments bring relief to sufferers of spinal fractures
One morning, Irene found she could barely get out of bed. Luckily, she had a lift chair at home. Unfortunately, that's also where she had to sleep and where she had to sit all day long.
"It hurt so bad that I literally screamed," Irene says. "When you live alone, there is no one to hear ... or help. I knew something was seriously wrong."
What Irene didn't know at the time was that she had one of the approximately 700,000 vertebral or spinal fractures suffered each year — usually in women over the age of 60. Her fracture had occurred seemingly without incident. She had not fallen and didn't remember even twisting the wrong way.
At first, Irene tried to see an orthopedist whose office referred her to a pain management clinic. She wasn't satisfied. "I had a sense there was more than pain that needed attention," she says. So she went to her primary care doctor who suggested an MRI, which revealed the spinal fracture.
Her doctor recommended that she see Aubrey Palestrant, MD, a board-certified interventional radiologist who performs two innovative procedures called vertebroplasty and kyphoplasty at John C. Lincoln Deer Valley Hospital.
Dramatic Pain Relief
Vertebroplasty and kyphoplasty are safe, minimally invasive procedures that use medical quality glue to repair and reinforce spinal fractures. "The procedures are extremely effective in reducing pain, helping to prevent future fractures and improving quality of life," says Dr. Palestrant.
Performed on an outpatient basis with conscious sedation and local anesthesia, vertebroplasty and kyphoplasty are used mainly in cases of vertebral fractures associated with osteoporosis, multiple myeloma and other cancers. Absent these procedures, treatment for spinal fractures is usually limited to pain medication and bed rest.
Irene had an osteoporadic fracture, and Dr. Palestrant thought she was a good candidate for kyphoplasty.
"He explained everything thoroughly, including the risks," Irene says. "I never hesitated. There are risks with everything. My pain was excruciating and I thought, 'Why live with it when something can be done?'"
Following her first kyphoplasty, Irene had a vertebroplasty and yet another kyphoplasty for additional fractures. Four months after her last procedure, she was still pain-free.
"Vertebral fractures, especially compression fractures that result in hunchback posture, are serious," says Dr. Palestrant. "Not only do they cause pain, but they often lead to decreased mobility, impaired lung function, insomnia and appetite problems."
The Glue Fix
In the kyphoplasty procedure, Dr. Palestrant uses high-tech imaging equipment to guide the insertion of two needles through the skin and tissue surrounding the spinal column and into the collapsed vertebra. Through each needle, he inserts and inflates a tiny kyphoplasty balloon to expand the vertebral body and restore its height. He then deflates the balloon and injects bone cement into the balloon cavity.
The cement sets within 20 minutes, permanently stabilizing the fracture. Pain relief occurs as the fracture stabilizes.
Vertebroplasty is a similar procedure used when the balloons are not necessary to reshape the vertebral body. The interventional radiologist or an orthopedic surgeon inserts the needles into the fractured vertebra and injects the cement.
For Irene, the procedures were easy and painless. "Dr. Palestrant really puts you at ease," she says. "He has a fabulous crew at the Deer Valley Hospital. They make you think you're the most important person in the world. I wasn't scared or worried."
Balloon kyphoplasty works only if the fracture has not healed in a compressed shape, so it's essential to seek treatment as early as possible.
Dr. Palestrant recommends that patients see their doctors if they experience sudden onset of severe back pain whether related to a traumatic incident such as a fall or not, if the pain persists or is worse by the end of two weeks. An MRI is the most reliable method to diagnose the presence of an acute fracture.
Prevention Is Best
While vertebroplasty and kyphoplasty effectively "fix" fractures, prevention is a better solution.
"It's extremely important to treat the underlying cause of fractures, which often is osteoporosis," says Dr. Palestrant. "Women should get a scan that measures bone calcium and take medication if they are at risk."
Irene knew she had osteoporosis, but she never dreamed it was bad enough to result in a spinal fracture. In her late 70's, she had a bone density test and has been on osteoporosis medication ever since.
Irene echoes Dr. Palestrant's advice to women: "Get screened early." Her advice to anyone who has osteoporosis: "Learn about spinal fractures and then about vertebroplasty and kyphoplasty. Someday these procedures may change your life. I'm very thankful I met Dr. Palestrant and that I could have the procedures at John C. Lincoln, right here close to my home."
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