Osteoporotic Spinal Fractures: Painless Recovery

Percutaneous Vertebral Augmentation -the treatment of choice for Osteoporotic Spinal or Vertebral Fractures to ensure a quick painless recovery and to prevent collapse/retropulsion of the vertebral fracture and other serious complications of osteoporotic spinal fractures

What is Osteoporosis

Osteoporosis is age-related weakening of the bones. Sometimes, medications required for other diseases such as steroids can weaken bones even at a relatively younger age. Age-related osteoporosis is more common among post-menopausal women.

What are osteoporotic spinal or vertebral fractures

Osteoporotic vertebral or spinal fractures are low-fragility fractures of the bones of the spine (mostly in the dorsal and lumbar spine) without severe trauma due to weak bones. Low-fragility osteoporotic vertebral fractures are a sign of severe osteoporosis

What are the initial symptoms of osteoporotic spinal or vertebral fractures

Osteoporotic vertebral or spinal fractures present initially with back pain, mostly severe

How serious is an Osteoporotic Spinal or Vertebral Fracture and what can happen if osteoporotic spinal or vertebral fractures are not treated on time and thereby what are the risks of trying to walk with a fractured spine

1. Osteoporotic vertebral body fractures present initially with pain, mostly severe.
2. The fractured soft weak vertebral bodies can collapse further with weight bearing and retropulse backwards compressing and even damaging the spinal cord. This is the biggest risk of having osteoporotic vertebral or spinal fractures. Unfortunate patients may present with sudden weakness or even total loss of power in both lower limbs along with loss of bowel/bladder control due to acute spinal cord injury caused by retropulsion of the fractured weak vertebral body. This can be a catastrophic presentation because neurological recovery after spinal cord injury is always unpredictable despite surgery.
3. Therefore, it is imperative that patients undergo MRI of the spine with significant pain to pick up osteoporotic vertebral body fractures before they collapse or retropulse and lead to spinal cord damage.

How are osteoporotic spinal or vertebral fractures diagnosed

1. X-rays can pick up only gross fractures and will not be able to differentiate a new fresh fracture from an old healed fracture. Therefore, x-rays can be highly unreliable.
2. MRI would diagnose correctly the levels and severity of osteoporotic vertebral fractures and the extent of compression on the spinal cord and the extent of spinal cord damage. Additionally, MRI would be able to crucially differentiate new fresh fractures from old healed fractures. New fresh fractures cause pain and are prone to further collapse/retropulsion and thereby need to be addressed urgently.

What is the medical treatment for osteoporotic spinal or vertebral fractures

1. Medical management of Osteoporosis is of utmost importance to prevent further Osteoporotic Fractures. Low-fragility osteoporotic vertebral fractures are a sign of severe osteoporosis and thereby patients need to be treated aggressively with medical management to prevent further Osteoporotic Fractures.
2. As about a fresh osteoporotic vertebral fracture, medical management is indicated if the patient has only mild pain and the MRI does not show any sign of collapse with retropulsion.

What is the best treatment for painful fractured osteoporotic vertebrae or What is the best treatment for osteoporotic spinal or vertebral fractures to provide quick pain-relief and to prevent them from collapsing further and retropulsing backwards leading to spinal cord damage

An aggressive approach is required for patients with severe pain or if the MRI shows a fresh fracture with even minor collapse/retropulsion.

Unfortunately, patients along with physicians often adopt a conservative approach with bed-rest, bracing and calcium/vitamin D supplements. This can be highly counterproductive because months of bed-rest are required before relief of pain and such prolonged bed-rest actually increases osteoporosis and can lead to bed-bound complications such as pressure sores, chest infection and urinary infection in the elderly. Moreover, bed-rest can never be complete and even minor weight-bearing can lead to further collapse/retropulsion of the fractured vertebra and compression/damage of the spinal cord.

What is Percutaneous Vertebral Augmentation for osteoporotic spinal or vertebral fractures

This surgery is called Percutaneous Vertebral Body Augmentation because the strength of the fractured weak vertebra is augmented immediately by a percutaneous procedure.

Percutaneous Vertebral Body Augmentation-tricks for success

I plan out the entry point and entry angle of the needles on pre-operative CT/MRI thereby decreasing x-ray exposure (to both the patient as well as myself) and also ensuring more exact placement of the needles. I use a bipedicular approach meaning I place two needles on each side of the vertebra to ensure even distribution of bone cement across the entire vertebra. In addition, I often use a hydraulic pump to inject the cement in a slow graded fashion which increases the safety of the procedure and also increases the amount of cement deposited in the fractured vertebra.

How fast is the recovery to normal life from and how successful in reducing pain is Percutaneous Vertebral Augmentation for osteoporotic spinal or vertebral fractures

Percutaneous vertebral body augmentation strengthens the vertebra and prevents further collapse/retropulsion and thereby spinal cord damage.

Vertebral Body Augmentation is an excellent patient-friendly percutaneous intervention for painful/soft spinal fractures or vertebral fractures liable to further collapse and spinal cord compression.

Conclusions

• Vertebral Body Augmentation is an excellent patient-friendly percutaneous intervention for painful spinal fractures/soft spinal fractures liable to further collapse and spinal cord compression
• Operative nuances include Accurate pre-op planning (decreases x-ray exposure to patient/healthcare personnel and ensures more exact placement of the needles) Bipedicular approach (two needles on each side of the vertebra to ensure even distribution of bone cement across the entire vertebra) Hydraulic Pump (injects the cement in a slow graded fashion which Increases the safety of the procedure and also increases the amount of cement deposited in the fractured vertebra)
• The above operative nuances Increase safety/accuracy, decreases x-ray exposure and increases volume of cement injection
• Patients with severe pain have rapid pain relief within hours/days enabling the patient to get out of bed and ambulate without pain. Thus, it is one of the most gratifying spinal surgeries.

Dr Sujoy K Sanyal’s treatment paradigm in improving safety and accuracy of needle placement and safely maximizing cement volume delivery in Percutaneous Vertebral Body Augmentation

Devised an unique pre-operative planning paradigm to improve accuracy and safety of needle placement for Percutaneous Vertebral Body Augmentation. Combined this with the use of a hydraulic pump in safely maximising cement volume injection in Percutaneous Vertebral Body Augmentation.

Patients with severe pain have rapid pain relief within hours/days enabling the patient to get out of bed and ambulate without pain. Thus, it is one of the most gratifying spinal surgeries.

Invited Faculty on Minimal Access Spine Surgery

• World Federation of Neurosurgical Societies (Interim meeting), Rome,Italy, 2015
• 5th WFNS Spine Committee Biennial Conference, Bali, Indonesia, 2018
• Spine Surgery in the XXI Century, Serbia, 2018
• World Spine VII, Delhi, India, 2016
• Asian-Australasian Congress of Neurological Surgeons, Jeju Island, South Korea, 2015
• Asian-Australasian Congress of Neurological Surgeons, Jeju Island, South Korea, 2015
• 3rd International Congress on Minimally Invasive Neurosurgery, Cairo, Egypt, 2016.
• Asian Australasian Congress of Neurological Surgeons, Jerusalem 2022