The pain and disfigurement of osteoporosis of the spine may be prevented with the help of a liquid bone cement, according to new findings being presented by University of Maryland Medical Center radiologists at the 25th Annual Meeting of the Society of Cardiovascular & Interventional Radiology (SCVIR) in San Diego, CA on March 28.
In a minimally invasive procedure called percutaneous vertebroplasty, sterile liquid cement, with the consistency of toothpaste, is injected into the fractured vertebral bodies of the spine. The cement fills the tiny holes and crevasses and strengthens the collapsed vertebrae, relieving pressure and pain.
"Vertebroplasty may also prevent severe deformity due to repeated fractures," says Gregg Zoarski, M.D., director of Diagnostic and Interventional Neuroradiology at the University of Maryland Medical Center and associate professor of Radiology at the University of Maryland School of Medicine in Baltimore. Dr. Zoarski is the lead investigator for the study.
After an initial fracture, typically there's a loss of 20 to 30 percent of the height of the vertebral body within the spine. Over several weeks, more fractures may occur and the vertebral body may collapse even further until eventually there's a 70 to 90 percent loss of height.
"Gradually, the back hunches over and the person loses height, especially if several vertebrae are involved," says Dr. Zoarski. "If we treat patients soon after each fracture, we can minimize their deformity," Dr. Zoarski says.
In the six-month study, 30 patients were treated with vertebroplasty. Immediately after the procedure, 29 out of the 30 patients reported significant pain relief. Patients answered questions about their level of pain and physical and mental functions several hours before and two weeks after the procedure. Eighty percent reported significant and durable pain relief two weeks after having vertebroplasty. The procedure takes less than an hour and the patient receives only mild sedation. None of the patients in the study had gotten better with conventional therapy consisting of bed rest and pain relievers.
"Vertebroplasty is most often used to treat vertebrae in the lower and mid-spine which are prone to fracture when they become brittle. In a third of the cases, the bone is so weak that the fracture may occur when the patient is simply rolling out of bed or coughing," says Dr. Zoarski.
"Often, because the patient can't recall a specific trauma, osteoporotic vertebral fractures are frequently diagnosed incorrectly as muscle spasm," he says.
Ten million Americans have osteoporosis, a disease that causes 700,000 vertebral fractures annually, according to the National Osteoporosis Foundation.
Osteoporosis causes bones to become more fragile and break easier. It is a disease that leads to more than twice the number of vertebral fractures as hip fractures. Those most at risk of osteoporosis are women over age 50 or individuals taking certain drugs such as steroids that accelerate bone mineral loss.
Patients who are candidates for percutaneous vertebroplasty undergo MRI tests to make sure their pain is caused by the fracture and not by other back problems such as herniated disc or compression of the spinal cord. The cement is injected into the spine with a needle. Doctors use x-rays to guide them. The cement then hardens after about 20 minutes and is permanent. The cement does not impair mobility of the spine and patients can move normally once the cement is in place.
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