Is the painful process of putting the backbone in its place over? With the help of vertebroplasty, pain is lowered significantly and that improves functions in the fractured vertebrae
OSTEOPOROSIS is one of the most common diseases in the country. Females are more prone to this disease as compared to males. But more importantly, it is a painless condition, that is until a bone breaks due to this disease. It is not necessary that the patient has to endure an accident to break his or her bone.
A painful osteoporotic vertebral fracture can be a significant burden for the patients and their families. Other than the vertebral column, the bones most commonly involved in this ordeal are the hip and the wrist bones. In the eventuality of physical injury, physical functions and quality of life are severely impaired. Independent of pain, there is morbidity associated with spinal deformity.
In the thoracic spine (behind the chest), the lung capacity is decreased. In lumbar spine (behind the abdomen) there is loss of height, secondary to collapse of vertebrae. There is again loss of lung capacity and associated loss of appetite, secondary to poor nutrition. Additionally it causes chronic back pain, sleep loss, decreased mobility, depression and loss of independence
Medications to treat osteoporosis do not effectively treat the pain or the fracture and require over a year to reduce the degree of osteoporosis. However, there seems to be an answer in the form of vertebroplasty.
Vertebroplasty is a new technique that helps to decrease the pain and improve function in the fractured vertebrae. Medications taken for symptomatic relief of pain can lead to further mood and mental alterations that compound the medical condition.
A large study shows a 23 per cent increase in mortality in women older than 65 years with vertebral compression fractures compared with the same age population without fractures. The mortality rate increases with the number of vertebrae fractures.
Until recently these painful fractures were treated with bed rest, painkillers (narcotic), braces (jackets or belts) and time. However, bedrest accelerates bone loss and leads to muscle reconditioning, resulting in increased pain from both of these mechanism.
Other treatments for osteoporosis, that include hormone replacement, bisphosphonates and calcitonin, are important for the long-term treatment of this disease. But often do not provide short-term pain relief. There are, however, new minimally invasive techniques that have been developed to help and stabilise the fractured vertebra, decrease the pain and improve the function of individuals debilitated by painful osteoporotic vertebral compressed fracture
Vertebroplasty is the technique for the stabilization and to relieve the pain by introducing polymethylmethacrylate (bone cement) through 4mm incision into the broken vertebra under fluoroscope (x-ray) control. This procedure can be done either with general or local anaesthesia and may or may not require a stitch.
This is a safe procedure with minimal complication rate. By vertebroplasty the pain relief has 90 per cent success rate with a very short hospital stay. Immediate pain relief is the reason to make it more popular in the world.
People in our country are more prone to osteoporosis, mainly due to bad dietary habits and poor nutrition. The first step we need to take is to educate the general public by frequent public awareness programme to avoid getting osteoporosis. Post-menopausal steps to avoid osteoporosis should be clear to the entire women community. Steps like (eg. hormone replacement, bisphosphonates etc.) should be taken immediately to avoid fractures of the bones. Remember the old saying, “Prevention is better than cure”.
A screening programme should be designed for especially postmenopausal women. When osteoporosis is diagnosed, a prompt step should be taken to start them on anti-resorptive measures.
If the fracture is sustained, an earlier measure should be taken to stabilize the fracture so that the patient could be mobilized as soon as possible. Until recently we had an answer to all the fractures, except the vertebral compression fractures of the spine.
These patients were treated with bed rest, braces and painkillers. Now we have overcome this problem with this new technique of vertebroplasty. The patient can be mobilized pain free with no brace or support and can be discharged on the same day of the procedure. The complication rate of this procedure is less than four to five per cent.
So in conclusion, vertebroplasty is a quick, safe and a successful procedure for the vertebral compression fractures and is worth doing this procedure to avoid the potential complications of immobilization of the patient. n
Vertebroplasty was performed for the first time in Pakistan by the author last month.
Yet another first in Pakistan
Recently, brain aneurysm was treated for the first time in Pakistan with the help of coiling. This procedure, supervised by Dr Tanveer-ul-Haq, was performed on a 57-years-old female, who had had a minor episode of brain haemorrhage.
An angiogram revealed a small aneurysm in the back side of the brain. The aneurysm was treated with four platinum coils by angiographic technique. The procedure was uneventful and the patient recovered immediately after the procedure.
Aneurysms are basically small balloon-shaped swellings in the arteries of brain. These are either present since birth or formed later in life due to hypertension or changes in the flow dynamics of the brain. They are the weak points in arteries and prone to rupture resulting in brain haemorrhage. Patient’s symptoms depend on the amount of leaking blood and range from headache to un-consciousness and death. Once the vessel ruptures, chances of re-rupture are about 30 per cent in the first month which can be life-threatening. Therefore, treatment to seal off these aneurysms is essential.
The usual mode of treatment in Pakistan until now is by open surgery in which the aneurysm neck is clipped. Surgery has its own major risks, especially on the backside of the brain. Sometimes, it is not possible to reach aneurysms at certain places in the brain.
Coiling procedure is a new technique in which the treatment is done by angiography without any surgery. In this technique a small micro-tube is advanced from the groin artery into the brain artery under x-ray visualization.
Then the aneurysm is packed with platinum coils by this special technique. Once the aneurysm is packed, the lumen is occluded and no chance remains of re-rupture. The parent artery remains intact and there is no danger to the brain. The recovery is much faster than surgery and the patient can go home the next day.
Common spinal diseases in Pakistan
List of the diseases according to the prevalence:
• Spinal Tuberculosis
• Spinal deformity
• Vertebral Fractures
• Spondylolisthesis secondary to Lysis
• Spinal Tumours
Spinal diseases are most frequently seen in Pakistan but Unfortunately badly treated because of the expensive treatment. Majority of the Spinal Surgeons are working in the private institutions where an ordinary person cannot afford to get treatment.
Is the painful process of putting the backbone in its place over? With the help of vertebroplasty, pain is lowered significantly and that improves functions in the fractured vertebrae 
