Source: The Hitavada      Date: 09 Apr 2018 11:33:42




■ By Dr Arvind G Kulkarni A njum, 58 years old lady was suffering from severe and consistent back pain for over 2 years. She was extremely obese (class 3) weighing 104 kgs. She was also suffering from uncontrolled diabetes and had suffered a fall last year. Due to the severe and disabling back pain, she was on bed rest since then. Upon showing to several doctors, she was on medications for a year but her pain did not subside. Her condition worsened with time and was not even able to get up, stand or walk even with support. Upon investigation through X-rays and MRI, when she presented to us, she was found to have a fracture in her L3 level of her spine which required attention. But keeping in mind her obesity and uncontrolled diabetes, which was a major challenge in her treatment an immediate discussion was called upon for. The team decided to perform the minimally invasive Vertebroplasty spine surgery. Healing in diabetic patients is very slow and hence this minimally invasive surgery would be the best option. The minimally invasive procedure was performed under local anesthesia and light sedation. Two small stab wounds were made on the skin using specially designed needles, which were inserted in the vertebral column under the guidance of X-rays. Bone cement made up of PMMA (PolyMethylMethAcrylate) was injected into the fracture site and allowed to settle down for few minutes. The bone cement provides instant support at the site of the fracture by forming a mould inside the vertebra and prevents further collapse. The procedure was performed in less than 20 minutes under local anaesthesia with the patient being awake during the procedure. The patient was made to stand and walk after 3 hours of the procedure. No complications or adverse events were seen due to her high diabetic profile. Her pain had vanished completely and she was discharged the next morning itself. This procedure worked like ‘magic’ in this highly obese patient. What is Vertebroplasty? In India, more than 5 crore people suffer from osteoporosis, and with age the bone mineral density decreases leading to thinning of bones. This raises the risk of bone fractures, especially in the spine. Though thinning of the bones can occur at any time, but is most common in elderly persons. ‘Compression’ fractures are caused when the weakened bone of the spine collapses and causes severe back pain. When several of the bones collapse, loss of height or stooped posture may occur. In most of the patients, the pain continues because the crushed bone continues to move and break. Most fractures of the spine are treated with bed rest until the pain goes away. Pain medicines, back braces and physical therapy may also be used. Sometimes, patients may need surgery to secure the spine using a bone graft or an internal metal device. Recently, a new non-surgical treatment called ‘vertebroplasty’ is being used to help hold the fractured bone in place and relieve pain. Patients who are unresponsive to conservative therapy of bed rest, analgesics, and back bracing should be considered for vertebroplasty. Vertebroplasty is a newer non-surgical technique in which medical grade cement is injected though a needle into a painful fractured vertebra body. This stabilises the fracture, allowing most patients to discontinue or significantly decrease analgesics and resume normal activity. Vertebroplasty is also useful in painful or unstable benign and malignant vertebral lesions that fail to respond to the traditional conservative therapies like multiple myloma, hemangioma and various spinal bone cancer. Many patients feel pain relief right away after vertebroplasty. Most report that their pain is gone i m m e d i a t e l y after the procedure and the patient is able to resume to normal activity within a day. Vertebroplasty is very safe.The bone cement used to secure the broken bone is safe. If you have significant back pain caused by a broken bone (osteoporotic fractured vertebra) in your back that is not getting better after one to two weeks of bed rest and pain control medicine, you may need vertebroplasty. Newer fractures tend to respond better than older fractures; however, some older fractures can be treated successfully. The success rate for this procedure in treating osteoporotic fractures is about 90-95 per cent. Vertebroplasty can effectively treat aggressive hemangiomas of the vertebral body and may be palliative in patients with malignant pathologic fractures. What are the advantages of Vertebroplasty? Decreased pain - Vertebroplasty reduces and in some cases eliminates the need for pain medication, and it also restores mobility in many patients. Increased functional abilities - Vertebroplasty stabilises the fracture, decreases pain dramatically and allows a return to the previous level of activity. Prevention of further vertebral collapse - The cement fills spaces in bones made porous by osteoporosis, strengthening the bone so that it is less likely to fracture again. No risk of infections - As the procedure is done through 3 mm incisions, the healing is very fast and no complications or infections are involved. No anesthetic effect - It is done under local anesthesia so no complication of total anesthesia. Daycare procedure - More over it is a fast procedure so the surgery time is very less (<30 minutes). And as the cement hardens quickly and pain reduces immediately patient is able to walk after a few hours of the procedure and can go home the same day. (The author is Head of Mumbai Spine Scoliosis & Disc Replacement Centre, Bombay Hospital, Mumbai) ●