Dr. Michael Connelly practices Pain Medicine in Lawrence, MA. Pain medicine is concerned with the prevention of pain, and the evaluation, treatment, and rehabilitation of patients experiencing pain. Pain medicine physicians use a broad-based approach to treat all pain disorders, ranging from pain as a symptom of disease... more
Procedure for Vertebral Compression Fractures Caused By Osteoporosis Reduces Risk of Mortality
By: Dr. Michael Connelly, New England Neurological Associates, Lawrence, MA
John’s life is anything but typical. Even at the age of 81, this Massachusetts resident works full-time as a CPA and stays active with four grown children, eight grandchildren and seven great-grandchildren.
However, in April, while walking to the bathroom one night, John fell. At first, he simply decided to rest and allow himself to heal. But after a few days, the pain from his back intensified to the point that it became almost unbearable. Yet, even with the debilitating pain, John refused to take medicine and instead chose to tough it out, “Tylenol did nothing for me and I had no interest in taking prescription painkillers despite the fact that my pain was an eight or nine out of 10 most of the time,” he said. Eventually, John made his way to his primary care physician, who referred him to me.
X-rays confirmed that John had not only broken two ribs and his clavicle, but also two vertebrae, a condition known as a compression fracture, or VCF. The broken vertebrae explained his intense lingering pain. Although a person might be active and eat well, aging puts people at risk for bone density loss. When osteoporosis develops, we become fragile and fractures can occur easily. Whether living independently or in a senior care community, accidents happen and the results can be life altering.
The numbers aren’t in our favor
The statistics are staggering. Worldwide, one in three women over age 50 will experience osteoporotic fractures, as will one in five men over 50. According to the Department of Health and Human Services office of the Surgeon General, by 2020, one in two Americans over age 50 will be at risk for fractures from osteoporosis and low bone mass.
And according to The Breaking Spine, a benchmark report issued by the International Osteoporosis Foundation, two-thirds of spinal osteoporotic fractures remain undiagnosed and untreated due in part to lack of awareness about osteoporosis and available treatment options. This condition, VCF, is most commonly caused by osteoporosis, but also can result from some forms of cancer. Spinal fractures can occur from something as simple as coughing, sneezing, turning the wrong way, or even bending over to pick up something off the floor.
As we learned from John’s case, these fractures can result in serious negative health issues, such as back pain, loss of height, deformity, immobility, increased number of bed days, and even reduced pulmonary function. Their impact on quality of life can be profound as a result of loss of self-esteem, distorted body image and depression. Vertebral fractures also significantly impact activities of daily living and risk for mortality.
Traditional treatment for spinal fractures includes pain medication, physical therapy, and back bracing. While these therapies may help some patients effectively, it is not adequate for many and does not treat the deformity related to the osteoporotic fractures. Many patients suffer in pain for too long before seeking treatment, due to a lack of awareness about spinal fractures and alternative treatment options. It is also common for patients who have one compression fracture, to develop another one due to their osteoporosis. This risk ranges from 10% to 25% over the next year, no matter how the first one is treated.
The breakthrough procedure
There is now help for patients with a compression fracture, which offers pain relief quickly and is associated with a lower risk of other medical complications and death. This minimally invasive procedure is called balloon kyphoplasty, and it’s designed to stabilize compression fractures and may significantly restore the vertebrae to the correct shape and size. It reduces back pain and the number of days in bed, significantly improving mobility, increasing overall quality of life, and decreasing chronic pain medications compared to traditional treatment options. During a balloon kyphoplasty, orthopedic balloons are inserted then inflated to expand the compressed vertebrae . The balloons also create a cavity that is filled with thick bone cement, and alleviates the pain by making the bone stable and strong.
Randomized trials have shown improvement in pain, and higher activity levels up to one year after kyphoplasty compared with patients treated without the procedure. Review of a large database of Medicare patients in the use revealed shorter length of stay for patients hospitalized with a compression fracture, a higher percentage of patients discharged to home rather than rehabilitation facilities, and lower rates of readmission to the hospital. The same database of nearly one million patients indicated lower rates of morbidity and mortality with kyphoplasty compared with those treated without kyphoplasty.
In addition to treating benign compression fractures, the procedure can also be used to treat fractures, fractures due to bones weakened by cancer, such as multiple myeloma or other cancer that spreads to the bone. The spine is the most common location of cancer that has spread to the bone. The treatment guidelines for metastatic compression fracture includes kyphoplasty followed by radiation therapy. Kyphoplasty treats the pain quickly and radiation controls the tumor. There is also a growing interest in the use of radiofrequency (RF) energy to destroy cancer cells at the time of kyphoplasty. With a procedure called Osteocool, water cooled RF probes are placed to specifically target heat energy to kill the cancer cells. Once this is done, balloon tamps are placed and kyphoplasty is completed.
For healthcare providers, it is important to identify individuals at risk. Bone health is best maintained over a lifetime by attention to key preventative strategies; adequate calcium, adequate vitamin D, weight bearing exercises, and awareness of personal risk (e.g., family history, tobacco use, steroid use, rheumatoid arthritis). People at risk should have their bone mineral density assessed, and treated with medication to reduce their risk of fracture if indicated by their testing and history.
John describes the 45-minute procedure as “No big deal. You’re aware, but you feel nothing,” he said. He could not believe the immediate pain relief he felt afterwards, “I rolled into the hospital in a wheelchair and walked out with a cane the same day. Words can’t describe it. I would recommend this procedure to anyone.” Only two weeks after the procedure, John said he was “99 percent back to normal.” Thanks to balloon kyphoplasty, John can get back to work and his family, doing what he loves.