I'm Dr. Chambliss Harrod. I 'm one of the spine surgeons at The Spine Center, in Baton Rouge,
Louisiana. Today I'd like to talk to you about osteoporotic compression fractures
really they're one of the most common problems that we face as we grow older which hopefully
all of us do get older and this day and age it's become very common as people live into their 80s,
this problem is becoming much more prevalent, and what you have is first off understand
a very common problem perhaps osteoporosis is one of if not the most common musculoskeletal problems
that we have and that we have to deal with as orthopedic surgeons and unfortunately a lot of
times you as the patient. Now compression fractures what your problem is today is
just that it's a break in the bone. Now this is a model here to show you. This is the pelvis and
coming off the pelvis is the spine. The first part of the spine is the lumbar spine and then right
above that is the thoracic spine and then lastly the cervical spine is what connects our head to
the remainder of our body. Now the cervical spine is very rarely to be involved in having
osteoporotic compression fractures it's the thoracic and then the lumbar spine which is
where the majority of these problems happen and if you're wondering why that happens it's because
these areas of the bone, unlike the bones in the neck, although they're larger, as we grow older
the inside of the bone is filled with what we call spongy bone or cancellous bone not the hard bone
that we can feel on the outside so this shows you the internal architecture or framework which looks
okay here but as soon as you look at it here you can see how it's really spongy
and that it's porous hence the term osteoporosis or bone porous spongy bone essentially and so this
shows you what happens and instead of having a nice solid square like bone in the front what
happens is that it becomes weak and brittle and then will suffer a crack and it can tilt one way
or the other and create a scoliosis locally or it can more commonly create a kyphosis where somebody
begins to hump over. These type of fractures are the most common type of thoracolumbar fractures
and the most common and most prevalent problem for patients over the age really of 60 or 65.
What do you do if you're diagnosed with one of these? Well first we want to get pain relief
so you may require some medicines in addition to an anti-inflammatory. You may require a
little bit of medicine that may be a little bit stronger to help you with your pain and typically
a brace is a good option for most people to start with. Most of the time I'd say about 75%,
of the time with four to six weeks of medicine, activity modification,
and a brace you're going to be fine. You're never going to need any procedure. Now if a brace and
medicine don't work, there is another option for you and that's what I'm here to tell you about
which is a procedure called kyphoplasty. We can percutaneously with a needle insert it through
your skin and gain access to your bones in a safe manner to be able to then inject
cement or support. Now the technical name of cement is called polymethyl methacrylate or PMMA,
but what it is is something that's been around in orthopedics for probably about 50 years.
It's what we use in most joint replacements. It's the same exact cement that is utilized
in that area and that's what the vast majority of these types of cement augmentation procedures
are actually injecting in to make you feel better. Now what we actually do in a kyphoblasty
is first we used to take it and we did this at the hospital and sometimes we still do. It depends on
how sick you are and what your risk factors are. Of course we're still going to send you to your
primary care doctor to obtain a clearance and to stratify your risk and once we can select the
right spot for you, whether that's a hospital, a surgery center, or we even do it in the office. So
as we get older one of the more common problems that we're starting to realize
is that we don't really want to give people anesthesia or general anesthesia that really don't
that don't need it because we don't want to put you at risk to have potentially
difficulties with your memory and other adverse side effects that come with general anesthesia
so one thing that we can do is now we've traditionally done these in the hospital with
general anesthesia and now what we're doing with these is that we're actually doing probably about
85 to 90 percent of these in the office setting where we still have an anesthesiologist
that will come. He can start an IV, and it's essentially monitoring you as if you're having
the anesthesiologist except you're not in the hospital. You're not getting general anesthesia,
and he's giving you medicine similar to like getting a colonoscopy.
Then you're comfortable, and we can position you such where we can bring an X-ray machine in
we can see your spine we can identify the different landmarks of your spine and then
once we do that then we can identify the proper placements to be able to perform this procedure.
Now once we then have you set up properly on the table with the X-ray machine,
what we do is we actually anesthetize the skin with a local anesthetic that also will decrease
the pain that you have immediately as well as for the next few hours after the procedure and then
we'll stick needles in the proper placements into the bone. Once we have you in the proper position
and verify the needle placements, we then will blow up a balloon. Now what that balloon is,
is kind of if you zoom in here you can see it there's two balloons that get blown up and what
they do is that they actually create space inside the bone and they're also taking the bone that's
that's broken and elevating the end plate in most patients to try to restore your anatomy back to
a normal square rather than being a triangle because we don't want you to become somebody who
begins to get more and more humped over over time. That's a big problem that a lot of people are
going to be worried about, so we want to prevent that. And so, when it does that, the balloon
actually increases the space and creates a void in addition to elevating the edges of the bone.
Then we deflate the balloon, and we then will inject the cement slowly,
controlled under fluoroscopy where we're looking at it under the X-ray,
and we can see it in real time. And typically, this is something that takes overall probably
about 10 to 15 minutes to do and without having general anesthesia typically patients then recover
and typically go home within 30 minutes or so afterwards in a much more rapid fashion.
Then you're asking, "Well what can I expect after this type of procedure?" Well the great
news is that typically I tell people take it easy that day and then tomorrow. After you've
seen your primary care doctor it's back to getting back to your normal routine. You've got work to
do.You've got things to do, and this is what will allow you to throw the brace on the side
and then allow you to get back to being you and living an active lifestyle and doing the things
you want to do instead of going to the doctor's office. Let me tell you back pain is probably the
most common symptom for which people visit their doctor or at least one of the top two or three,
so you're not alone. Now most of the time, you're going to be able to push through. Typically take
some over-the-counter medicines; do the things that you've done in the past and be fine. However,
if it lingers a little bit longer, and you're not quite sure if there's something else going on,
give us a call or go to visit our website. We'll be glad to see you any and every day.