An elderly lady presents to Casualty with complaints of acute onset, severe pain in the mid back while getting out of bed in the morning. X ray shows collapse of the height of D12 vertebra.
A diagnosis of Osteoporosis is made by the Casualty doctor.
What do we do?
This is a common scenario in Orthopedic practice. The treatment options include:
1. Bed rest for 6 weeks,
2. Ambulation with Brace- Taylor brace/ Anterior spinal Hyper-extension brace
In elderly population, keeping the patient on bed rest for 4-6 weeks will invite a spectrum of issues like bed sores, hypo-static pneumonia, urinary tract infections, and accentuation of Osteoporosis.
So, we need to keep the patient ambulatory, unless the fracture configuration is unstable.
The principle behind bracing is to prevent flexion at the site of fracture, as this will increase the deforming forces. But the collapse that has already occurred, does not revert.
This eventually leads to progressive dorsal curvature of the spine with the fracture level acting as apex. This may further produce secondary narrowing of the spinal canal, producing risk to the spinal cord and nerve roots.
So, something needs to be done that takes care of the pain and maintains the vertebral height.
The answer lies in Kyphoplasty.
This technique involves inflating the interior of the collapsed vertebral body to restore the contour, and then injection of bone cement to fill the space.
Kyphoplasty is theoretically superior to Vertebroplasty. The latter involves injection of cement into the collapsed vertebra without elevating it.
Thus Vertebroplasty can produce pain relief in a Vertebral collapse fracture by de-nervation using bone cement heat of polymerization, but it does not prevent a subsequent kyphotic deformity.
However, the drawback of Kyphoplasty lies in its cost.
Further study needs to be performed regarding the cost- benefit analysis between Vertebroplasty and Kyphoplasty.