FEMH Magazine

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  • 2023-08-01

Invisible Killer - Osteoporosis and Compression Fractures

Orthopedics Department Chen, Yu-Hung Doctor

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        Taiwan is moving towards what the United Nations refers to as a "super-aged society," and one of the major prevalent diseases in such a society is osteoporosis. Osteoporosis is a significant concern due to the severe consequences of related fractures, with hip, spine, and wrist fractures being the most common. According to statistics, there are approximately 60,000 cases of spine compression fractures caused by osteoporosis in people aged 65 and above in Taiwan each year. These low-impact fractures often occur due to minor slips or falls, but since the spine bears the body's weight, they can result in severe back pain and limitations in daily activities.

          The majority of patients with these fractures can be treated conservatively, which involves bed rest, pain medication, and the use of back braces. The treatment duration typically takes around 12 weeks, allowing the fractured spine to gradually heal to a stable strength. As the fracture heals, back pain improves, and the time for mobilization increases.

          However, conservative treatment has its drawbacks. The height of the vertebral body may gradually collapse before the fracture fully heals. Prolonged bed rest can also lead to serious complications such as bedsores, pneumonia, and urinary tract infections. Some patients may experience persistent lower back pain due to kyphosis (hunchback) resulting from prolonged immobilization. In the most severe cases, surgery may be required to decompress the nerves and stabilize the spine with the insertion of bone screws. Although such severe situations are rare, they can lead to irreversible disabilities, emphasizing the need for caution.

        Percutaneous vertebroplasty is a procedure where artificial bone cement is injected into the fractured vertebral body to provide stability and prevent excessive collapse. It is a minimally invasive surgery that can quickly relieve pain and accelerate the patient's recovery. The procedure involves the following steps:

 The patient receives local or general anesthesia.

      The surgeon uses a puncture needle to access the collapsed vertebral body and slowly injects the flowable bone cement through a guiding needle to fill the vertebral space.

       The doctor monitors X-rays or other imaging devices to ensure the bone cement is in the correct position and an adequate amount is used.

       Once the bone cement has hardened, the surgeon closes the incision and performs sutures.

       The surgery usually takes about 30 minutes, requires local anesthesia at the injection site, has minimal blood loss, and the incision is less than 1 cm. Most patients experience significant pain relief after the surgery and can start moving within an hour. Patients typically can be discharged the next day but still need to wear a back brace for at least three months.

        Percutaneous kyphoplasty, also known as percutaneous vertebral augmentation, is a modified version of vertebroplasty. The procedure is similar, but it involves the use of a balloon-tipped catheter to restore the collapsed vertebral body before injecting the bone cement. This technique allows for better correction of vertebral deformity and reduces the risk of cement leakage, making the procedure safer. However, it is more expensive, and the cost of the balloon device is not covered by insurance.

       Both vertebroplasty and kyphoplasty are minimally invasive, rapid, and highly safe treatment methods compared to traditional spinal fixation with implants.

       As with any surgical treatment, there are risks and potential complications associated with vertebral augmentation procedures. Some possible complications include cement leakage (3-5%), nerve damage (<3%), and rare complications such as pulmonary embolism, myocardial infarction, or stroke related to cement leakage. Pain exacerbation, bleeding, and infection at the surgical site are also rare. Furthermore, adjacent segment fractures may occur due to osteoporosis.

         Bone cement, also known as polymethyl methacrylate (PMMA), is the material used in these procedures. It is different from industrial cement and is stored as a powder and liquid separately. When needed, the powder and liquid are mixed rapidly for about 30 seconds, and after a few minutes of chemical reaction, it forms a solid and pressure-resistant cement mass.

       In Taiwan, the National Health Insurance covers bone cement for vertebral augmentation procedures. However, there are specific reimbursement limitations and conditions, so it is recommended to consult with a healthcare professional for detailed information.

       Finally, regardless of the treatment method for vertebral compression fractures, it is important for patients to receive comprehensive care for osteoporosis. Lifestyle changes, fall prevention, physical activity, sun exposure, calcium and vitamin D intake, and osteoporosis medications are crucial for reducing the risk of future fractures.

       In conclusion, vertebroplasty and kyphoplasty have been developed for over 30 years, with significant advancements in materials and surgical instruments. These procedures offer an alternative treatment option for patients with compression fractures due to osteoporosis. The benefits include small surgical incisions, fast recovery, short hospital stays, and a high success rate of around 90%, making them effective and safe treatment methods recognized by physicians.


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A vertebral body that collapses due to osteoporosis is referred to as a compression

 fracture

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Fixing fractures by filling the vertebral body with bone cement through percutaneous vertebroplasty