Special Cement Can Treat Certain Spinal Fractures

Fractures of the vertebrae -- the bones of the spine -- are relatively common in people with osteoporosis and spinal tumors, but few treatment options are available. Vertebroplasty is a relatively new procedure in which a special cement is injected into weakened or collapsed vertebrae to harden the bone. The cement used, polymethylmethacrylate (PMMA), has been used to reconstruct bone during surgery for at least 20 years.

Vertebroplasty is performed to prevent or limit painful collapse of vertebrae, which encircle the spinal cord. Vertebroplasty also provides stability to the treated segment of the spine. Osteoporosis, which is bone loss due to hormonal conditions or old age, may not respond to medications and other treatments, leading to collapse or fracture of the vertebrae. Painful collapse of the vertebrae may also occur from certain malignant or benign tumors. Sometimes cancer will spread from its original site to the spine, for example. Vertebroplasty is appropriate for fractures or vertebral weakness caused by osteoporosis and tumors.

Fractures of the vertebrae cause significant pain and disability. Up to 50% of females 50 years and older will suffer osteoporotic fractures; 15% are vertebral fractures with the risk of pain, deformity and limiting in function. Of all cancer patients, an estimated 30-40% will have tumors that metastasize, or migrate, to the spine, causing pain, deformity and neurological damage. Fractures from osteoporosis and tumors usually can't be predicted, so patients may only receive treatment after the fracture has occurred.

Preventing vertebral fractures is difficult with today's limited treatment options. Osteoporosis patients may receive physical therapy, occupational therapy, back support or bracing, and take efforts to prevent falls. Cancer patients may receive radiation or chemotherapy to reduce the painful, crippling effects of the tumor on the spine. In some cases, when indicated by careful diagnosis, vertebroplasty may help prevent vertebral fractures. Not only does it reinforce bony elements of the spine, but it provides patients with a long-lasting, pain-relieving effect and improves the patient's mobility.

During the vertebroplasty procedure, the patient lies on a table. Most patients receive a mild sedative so they are conscious during the procedure. Those with more severe conditions receive a general anesthetic. The procedure is performed by a radiologist who uses a type of X-ray equipment to carefully insert a needle into the spine. Through the needle, cement is injected into each affected vertebra.

Possible complications include the puncturing of vertebral and other spinal tissue, cement leakage leading to compression, or squeezing, of the spinal cord or nerve roots, or infection of the vertebroplasty site. Overall, complications have been reported to be about 1% for osteoporosis patients and up to 10% for patients with metastasized spinal tumors.

Current Experience With Vertebroplasty

Osteoporosis fractures occur most frequently in women past the age of 60. Traditionally, vertebral fractures have been treated with painkillers, immobilization and management of osteoporosis in general (such as hormonal treatment or calcium supplements). Fractures usually lead to more fractures, as the individual becomes less active, which further reduces bone mass and increases the risk of breaking.

In a large percentage of osteoporosis patients, vertebroplasty has been demonstrated to dramatically reduce pain, provide stability and help prevent collapse of the vertebrae, particularly when used early in the course of the disease. In one study, 26 out of 29 patients with osteoporotic fractures reported significant immediate and long-lasting post-operative pain relief, with two minor complications and no major ones.

Cancer tumors that have metastasized to the spine often cause severe pain. Radiation therapy helps no more than 70% of cases and takes two to six weeks to provide relief. Furthermore, radiation therapy does not prevent fractures. Vertebroplasty, however, has been shown to provide long-term stability (100% at 13 months), immediate and long-lasting pain relief (73% at 6 months), and good functional improvement (70%) in most patients treated. This improvement in quality of life is very encouraging, considering the relatively short life expectancy of patients with metastasized spinal tumors.

Vertebroplasty has also been shown to provide excellent spine stabilization and pain control in treating patients with non-cancerous tumors called hemangiomas that are particularly aggressive, causing severe pain or compressing the spinal cord or nerve roots.

In theory, vertebroplasty is appropriate for any spinal tumor that is causing pain or threatens to fracture a vertebra. Research is ongoing, but it has been demonstrated as effective in treating the pain and vertebral collapse associated with osteoporosis, metastatic tumors of the spine and hemangiomas.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.