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Friday, February 8, 2013

From Dr Scurr.. Know more about vertebroplasty, that is injecting cement into the fractured vertebra to relieve pain and put back the strength of the backbone




The spine consists of a series of bony blocks, or vertebrae. The vertebrae are hollow at the back — the spinal cord runs down this channel. There are seven vertebrae in the neck, 12 in the chest (the dorsal spine) and five in the lubra region. 
With osteoporosis, the bone structure becomes weaker and crumbly, causing the vertebrae to collapse and fracture.  This is more common in the lower half of the dorsal spine and the lumbar spine, as they have the greatest load to carry. 
The crushed bone will heal with rest and time, but it will remain distorted, which is why some older people become shorter and hunched forwards. 
With vertebroplasty, ‘bone’ cement made of artificial plastic material is injected into a fractured vertebra to make the crushed bone hard and stable and so relieve the pain.
A large needle (almost as thick as a pencil) is inserted under general anaesthetic through the skin into the fractured vertebra.  The bone cement, a rapidly setting sort of glue about the consistency of toothpaste, is  cautiously pumped in (the whole process is monitored using X-ray technology).
There is a newer variation of vertebroplasty called kyphoplasty — a balloon is first inserted, using a similar needle, and then inflated to force the crushed vertebra to  expand, creating a cavity.

The balloon is withdrawn and the cement is then pumped into the cavity. One of my patients had this done this year, at St Mary’s Hospital,Paddington. 


Two of his vertebrae had collapsed and he was in considerable pain, but after vertebroplasty he was painfree the same day and did not need any more painkillers.  Following kyphoplasty she, too, was pain-free, and described her life as ‘transformed’.
However, there are potential complications: the bone cement must not be allowed to leak into the spinal canal where it could damage the spinal cord or nerve roots.
So the procedure needs to be done by someone with skill and experience.
And then there are the results of a large trial of vertebroplasty that compared the procedure with a placebo — half the patients had the cement injected, half went through the whole process, but without any actual cement being used.
The genuinely treated group were no better off after six months than those who’d received the sham treatment and who’d recovered spontaneously (although possibly were in pain for longer).
You do not have an easy decision, but if you want rapid pain relief rather than relying on painkillers for many weeks, the operation does seem an attractive option.

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