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.
Osteoporotic vertebral or spinal fractures present initially with back pain, mostly severe.
a. Osteoporotic vertebral body fractures present initially with pain, mostly severe.
b. 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.
c. 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.
a. 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.
b. 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.
a. 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.
b. 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.
Percutaneous Vertebral Augmentation- strengthen the fractured body before further collapse/retropulsion and 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.
This is actually not even an open surgery. It is a percutaneous procedure whereby 2 needles are guided under x-ray control from the back to the fractured vertebral body and a special kind of bone cement is injected through the needles under x-ray control into the fractured weak vertebral body. No surgical incision is made. The bone cement injected into the fractured weak vertebral body immediately strengthens the fractured weak vertebra and therefore offers almost immediate protection from further collapse/retropulsion and gives rapid pain relief to the patient within hours/days enabling the patient to get out of bed and ambulate without pain.
This surgery is called Percutaneous Vertebral Body Augmentation because the strength of the fractured weak vertebra is augmented immediately by a percutaneous procedure.
Postoperative recovery- Miraculous disappearance of pain and Quick return to daily life
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.
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.
Devised an unique pre-operative planning paradigm to improve accuracy and safety of needle placement for Percutaneous Vertebral Augmentation. Combined this with the use of a hydraulic pump to safely maximise cement volume injection in Percutaneous Vertebral Augmentation
