Spinal Fractures - From Osteoporosis,
Multiple Myeloma or Metastatic Disease
Introduction
Bone, the framework of the body, is made mostly of collagen (a
type of protein) and a mineral called calcium phosphate. Bone is
a living tissue, continually replacing itself through a process
of new bone growth (formation) and old bone removal (resorption).
During childhood and teenage years, formation occurs faster than
resorption. As a result, bones become larger, denser and heavier.
Then, at about age 30, resorption slowly begins to exceed formation,
reducing bone mass by about 1% each year. Events such as menopause
can trigger rapid bone loss. There are many other risk factors that
affect bone loss; most of which can be controlled.
What is osteoporosis?
 In
osteoporosis, bone (osteo) becomes porous (porosis). As a result,
bones are weakened and made brittle, becoming prone to fractures.
Often referred to as a "silent disease", osteoporosis
may have no symptoms until a painful fracture occurs. When the
osteoporosis occurs in the vertebrae of the spine, the vertebrae
may collapse.
This results in severe back pain, nerve pain or dysfunction, loss
of height, or spinal deformities such as kyphosis (severely stooped
posture).
What causes osteoporosis?
Poor nutrition or lack of exercise during the bone-forming years
can result in bones that are less dense than they should be. Bones
that are less dense are more likely to be affected by osteoporosis.
Smoking, excessive use of alcohol, lack of exercise and poor nutrition
during adulthood can cause bones to lose density.
Women with smaller, thinner bones are more prone to osteoporosis
and are also adversely affected by hormonal changes. Heredity and
ethnicity may also affect the chance of developing osteoporosis.
Secondary osteoporosis results from other health conditions, such
as hormone imbalances, arthritis and joint disease, certain medications
such as steroids, and some diseases or treatments of the digestive
system.
Can osteoporosis be prevented?
You can prevent or slow down osteoporosis by making healthy life-style
choices. Good nutrition, with sufficient amounts of calcium and
vitamin D are necessary for bone growth. Bones are living tissue
and become stronger with exercise.
Weight-bearing exercises, done consistently, make bones stronger.
These exercises may include walking, stair-climbing, dancing, and
tennis. Weightlifting, even if done with small weights, is beneficial.
Swimming and water exercises are useful for people who can't otherwise
bear weight. Not smoking and avoiding alcohol consumption reduce
bone loss. Regular consumption of just 2 to 3 ounces of alcohol
may be damaging to the skeleton, even in young adults.
What are the treatment options for spinal fractures due to osteoporosis?
Spinal fractures that result from osteoporosis can be surgically
treated, depending on the location of the fracture. Hip fractures
should be treated with reconstructive surgery within 48 hours, if
possible. Spinal fractures can be repaired using a procedures called
kyphoplasty and percutaneous vertebroplasty.
Kyphoplasty
 Kyphoplasty
is a type of vertebroplasty in which the vertebral body is first
prepared for the cement by using a balloon to inflate and reposition
the vertebra. As the cement hardens, the vertebral body may
resume a more normal shape. Kyphoplasty is minimally invasive,
requiring only a very small incision in the back. A narrow tube
is inserted through the incision using fluoroscopy to guide
it into the correct position in the damaged vertebrae.
 Using
the tube as a channel, the doctor then guides a special balloon
into the vertebral body.
  The
balloon is then carefully inflated, restoring the vertebrae
to a more normal shape.
It also creates a cavity in the vertebral body by compacting the
soft inner bone material.
 The
balloon is then deflated and gently removed. Special instruments
are used to fill the cavity with a soft cement-like material
which quickly hardens to stabilize the vertebrae.
With the vertebrae shape and height restored, the pressure on the
nerves is reduced, easing the pain.
Percutaneous Vertebroplasty
Percutaneous vertebroplasty uses an epoxy cement injected into
fractured vertebrae. The epoxy becomes rock-hard within minutes,
yet is light and supportive. The vertebrae must be treated before
total collapse. Percutaneous vertebroplasty does not necessarily
restore the physiological shape of the vertebra, but does reduce
further disintegration. Other injectable bone-mineral substitutes
that are similar to normal bone are being tested. Percutaneous
techniques (performed through the skin) derive their origins
and continued success from medical advances and patients' desire
for a less invasive yet effective therapy. The procedure uses
a local anesthetic and the patient is able to walk around within
a day.
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John
J. Regan, M.D.