Spinal Osteoporosis

Osteoporosis is a disease where the bones in the body become weak and break (fracture) easily. Osteoporosis is fairly common in India and usually affects post-menopausal women > 65 years old and men more than 70 years. It can occur at a younger age in Rheumatoid Arthritis; long-term use of steroids; paralysis patients; bed-ridden patients; and with long term use of medicines like warfarin, phenytoin, etc. Osteoporosis can be a silent disease unless it manifests itself in the form of a fracture of the hip, spine or wrist. Therefore, WHO recommends that Osteoporosis should be screened for in females > 65 years and men > 70 years.

The screening tests for Osteoporosis are the Fracture Risk Assessment Tool (FRAX Tool) and a Bone Densitometry (DEXA) scan. The FRAX tool is an online questionnaire that calculates the risk of suffering a major osteoporotic fracture over the next 10 years based on the patient’s age, sex and other risk factors.

WE RECOMMEND AGAINST THE USE OF PORTABLE DEXA MACHINES (HEEL DEXA MACHINES COMMONLY USED IN FREE BONE CAMPS) AS THEIR RESULTS ARE INVARIABLY UNRELIABLE.

Calcium and Vitamin D supplementation is not the treatment of osteoporosis. Depending upon the severity of osteoporosis and other factors your Spine Specialist may prescribe oral (weekly or monthly) Bisphosphonate tablets, injectable (once a year) Zoledronic Acid or a daily subcutaneous (like Insulin injection) Teriparatide hormone injection.  Patients with spinal osteoporosis can present with back pain, decrease in their height, roundedness of their back (Hindi – kubb) or fractures in their spine from minor trauma. They can suffer fractures from a simple fall at home; a slip in the bathroom; coughing, sneezing and bending; and some patients can get fractures even without any trauma.

Most patients that suffer an osteoporotic spinal fracture get better in 2-4 weeks. We do not recommend bed rest for these patients, but get them to walk as soon as they can tolerate it within the limits of pain. We may use a lightweight brace to get these patients to walk as soon as possible.We also use Calcitonin nasal spray in acute osteoporotic fractures as they give quick pain relief to these patients. The most important aspect in the treatment of an osteoporotic fracture is in recognizing it so that proper medical treatment can be initiated so that further osteoporotic fractures can be prevented.

Patients that continue to suffer from pain even at 3-6 weeks from a fracture may benefit from a cement injection procedure.(Kyphoplasty/ Vertebroplasty). Kyphoplasty / Vertebroplasty is a highly effective procedure for relieving pain in these painful Osteoportic Spinal Fractures.

This percutaneous procedure is particularly suitable for the elderly with multiple medical co-morbidities as general anesthesia; open surgery and blood loss can be avoided. The procedure involves injecting cement in the fractures spinal bone under the guidance of an X-ray. The injected cement gives immediate structural support to the fractured spinal bone, thereby relieving pain.

There is little to choose between Vertebroplasty and Kyphoplasty and both procedures are more or less similar. The risk of cement leakage is less with Kyphoplasty but Kyphoplasty is significantly more expensive than Vertebroplasty.

Some Osteoporotic Spinal fractures are not suitable for cement injection and they may need fixation with Titanium screws and rods. In these cases we typically use Cemented screws to increase the hold of screws in the osteoporotic bone. It is utmost important to start medical treatment for osteoporosis in parallel to cement injection / fixation surgery to prevent further fractures.

What to expect from a cement injection procedure (Kyphoplasty / Vertebroplasty)?

 You typically get admitted on the morning of the procedure. The procedure is done under local anesthesia without any external stitches. The procedure will take about 0.5 – 1 hour. The patient is made to walk the same evening and discharged. The patients are independent immediately after the procedure and there is no particular recovery period.