Treatment by bone cement injection

History:The patient was a 74-year-old gentleman who was followed by a rheumatologist due long standing osteoporosis and past fractures of the spine. At time of first consultation, the patient reported having pain in his mid-back for over a month. At first, treatment measures such as bracing, therapy, and medication were pursued. Despite this approach, the patient noted increased hunching forward and severe pain with walking and standing.

Physical Examination:The patient was a healthy appearing gentleman walking with difficulty due to back pain. Motion of the lower back was painful and thus restricted. Hip range of motion was painless and complete, neurologic examination of the legs was unremarkable.

Radiographic Evaluation:Standing radiographs of the spine revealed multiple old compression fractures of the lumbar and thoracic spine. At the T12 level a new fracture was noted on x-ray. An MRI study revealed bone marrow changes in T11 and T12. The other spinal fractures appeared healed.

Treatment Options:Osteoporotic fractures of the spine are relatively common and affect a significant number of elderly patients. In most cases the treatment of spine fractures in the setting of osteoporosis involves medication, bracing and activity modification. Proper evaluation and treatment for osteoporosis is essential. Newer medications have been shown to reduce the chance of repeated spine fractures.

In some patients, an osteoporotic spine fracture leads to progressive kyphosis and pain. Although most fractures do heal within several months, in some cases pain can be severe and persistent. New techniques have been developed to help stabilize a collapsing vertebra affected by osteoporosis. These techniques involve the injection of bone cement into the vertebra in order to prevent further settling. In carefully selected cases this can reduce the pain and stabilize the spine at that level.

Discussion:After thorough discussions with the patient regarding the treatment options, a decision was made to proceed with kyphoplasty. This technique involves use of a special balloon that is introduced through small skin incisions into the collapsed vertebra, inflation of the balloon to create a small cavity in the vertebra, and then injection of bone cement into this space. As the cement hardens the collapsed vertebra is stabilized.

Treatment Results:As planned, the patient was treated by cement injection and left the hospital on the following day. Upon return to the office one week later the patient was walking with good posture and without pain.

Kyphoplasty Surgical Procedure

Kyphoplasty Medical Condition