Lifestyle diseases are the newest concern today. Various spine-related illnesses like disc problems and osteoporosis are affecting the spinal column weakening it and leading to osteoporotic compression fractures in the latter half of life. The main cause of these kind of diseases in today’s age are hectic schedules, work-related stress, eating habits and most importantly lack of routine proper exercise in urban and semi-urban areas.
Osteoporosis, a disease characterized by low bone mass and structural deterioration of bone tissue, is often called the “silent disease” because bone loss occurs without symptoms. A person may not know they have osteoporosis until their bones become so weak that a sudden strain, bump or fall causes a fracture. Fractured vertebrae may result in severe back pain, loss of height or spinal deformities such as kyphosis (stooped posture).
Osteoporosis leads to bone fragility and an increased susceptibility to fractures of the hip, spine and wrist. We all need to take better care of our bones. The good news is that you are never too old or too young to improve your bone health.
Wolff’s Law (1868) states that bone mass and density will be increased in areas of stress. Conversely immobilization and non-weight bearing activity will cause a significant reduction in bone density. In other words, “use it or lose it.”
Osteoporosis leads to weakening of the individual vertebrae which collectively form the spinal column. Unable to sustain body weight, the vertebra collapses and fractures even with relatively small forces acting on it like trivial falls at home, with activities such as bending forwards or lifting a bucket of water or even a bout of coughing and sneezing. Impacts to spine while travelling through pot holes or on unrecognized speed breakers also result in spinal compression fractures.
The biggest drawback of this disease is that is usually does not get diagnosed unless there is a fracture or a mishap. However, there are some specialized tests called bone mineral density tests can measure bone density in various sites of the body.
A bone density test can:
- Predict risk of future osteoporosis and hip fracture
- Detect osteoporosis before a fracture occurs
- Determine the rate of bone loss and/or monitor the effects of treatment
Spinal fractures caused by osteoporosis are all too often dismissed as simple back pain or spasm hence and so often do not come to clinical attention, thereby remaining undiagnosed and untreated. Even when referred to a doctor, only about 40% of older women with spinal fractures visible on X-ray are tested for osteoporosis and the figure is even lower in men (less than 20%). It is essential that spinal fractures are identified and treated before further fractures occur. Unless treated, as many as one in five women with a spinal fracture will sustain another within twelve months.
Some facts and figures about osteoporosis- Approximately 26 million Indians are estimated to have osteoporosis with the numbers projected to reach 36 million by 2013
- At least one in three women and one in five men over the age of 50 will suffer a fragility fracture secondary to osteoporosis- most commonly at the spine, hip, wrist and ankle
- 30-50% vertebra fractures are misdiagnosed in radiology reports due to lack of detection or use of ambiguous terminology
- Clinical vertebral osteoporotic fractures associated with 8-fold increase in mortality
- 45% drop out rate from effective surgery only due to fear of surgery
Worldwide each year 1.4 million patients suffer from spinal fractures due to osteoporosis. Unfortunately, two-third of these fractures goes undiagnosed and untreated due in part to lack of awareness about osteoporosis and available treatment options. The consequences of untreated fractures can be devastating. When a patient suffers from one vertebral compression fracture, the risk of a second fracture increases five-fold. Left unattended, many fractures can result in an exaggerated rounded curvature of the spine, called kyphosis or Dowager’s hump. This condition is painful and debilitating - making walking, eating, sleeping, and even breathing painful and difficult, and long-term, this condition could be fatal.
Majority of patients with osteoporotic vertebral fractures are treated non-operatively with a short period of rest, pain medication and exercises. If pain persists resulting in functional limitation, then a procedure called Balloon Kyphoplasty advised which successfully relieves the pain in about patients.
Non-surgical treatments help in relieving pain or cause it to subside temporarily, but it doesn’t repair the fractured vertebra or address spinal deformity. In fact, treatment with nonsurgical methods allows the bone to heal in a deformed state and alters the overall alignment of the spine causing a Humpback deformity which affects the biomechanics and causes long term pain and reduces the quality of life.
Open spinal surgery is an invasive procedure that is generally considered if neurological damage is present. A less invasive surgery technique called Kyphon Balloon Kyphoplasty can treat pain and improve quality of life faster and better than conventional non-surgical treatment.
Balloon Kyphoplasty is a minimally invasive procedure performed by a spine specialist. It can be performed using either a local or general anaesthesia. It typically takes about one hour to treat each fracture and may require an overnight hospital stay. During this procedure a small incision is made in the back.
Balloon Kyphoplasty gently restores the height of the vertebra and corrects deformity by inflating two balloons in the fractured vertebra through small incisions in the skin. Once height is restored, the balloons are removed and the cavity they create is filled with thick bone cement at a low pressure. Balloon Kyphoplasty is a minimally invasive procedure that takes in general less than an hour to perform and leaves minimal scarring.
Before the procedure, the patient undergoes a medical exam and diagnostic studies such as X-rays and CT scans, to determine the precise location of the fracture and to assess the safety of the procedure. In case of spine, most people opt for non-surgical care as it is a common myth that surgery of the spinal cord has adverse side-effect. Yes, there are potential risks, but with the correct consultation the surgery can transform the life of patients, and Vertebroplasty and Kyphoplasty are minimally invasive procedures which cannot be labelled as surgeries.
Data suggests that even amongst patients who are recommended a surgical intervention for spinal fracture, very little percentage actually receive the right treatment. One of the major reasons for patients dropping out of surgical procedure is ‘fear’ of surgery. Unfortunately, despite the marked improvement that medical science has made over the decades, Indian patients suffer from a psycho fear and prefer leading their life in pain rather than getting the right treatment. Procedures like Balloon Kyphoplasty, Vertebroplasty etc. when performed on right patients by trained physician can lead to miraculous improvement in patient’s quality of life
Patients in India have very low confidence in these kinds of surgeries. However, the rate at which ailments of the spine like osteoporosis and osteoporotic spine fractures are growing, Indians need to open up to these methods of treatment, which are relatively risk free if the indications and methodology is correctly applied and will have a positively impact on healthy and painfree life.
(Author is a spine consultant, Wockhardt Hospital, Mumbai)