Repairing Spinal Fractures -- In-Depth Doctor's Interview
Marcel Maya, M.D., an interventional neuroradiologist at Cedars-Sinai Medical Center’s S. Mark Taper Foundation Imaging Center, explains the benefits of a minimally-invasive spinal procedure called vertebroplasty.
What is a compression fracture?
Dr. Maya: A compression fracture occurs when a vertebral body of the spine is crushed to a smaller height, due to a load placed on the spine exceeding its stability
How easy is it to get a fracture like this?
Dr. Maya: It is very easy to sustain these fractures, especially in elderly women who have weak bones due to osteoporosis. They can just sneeze or cough and sustain these fractures -- even picking up a small object from the floor, getting in and out of the car, just getting out of bed -- they can have these fractures.
Are injuries like these easily diagnosed?
Dr. Maya: Many times, these are not diagnosed properly because patients don’t recall a traumatic incident or a certain fall or event, so the doctor doesn’t have suspicion for a fracture. Doctors need to have a higher index of suspicion to diagnose these conditions.
How do you look for compression fractures?
Dr. Maya: It is quite easy to detect on a plain x-ray, but the best test would be an MRI of the spine.
What are the treatment options for compression fractures?
Dr. Maya: Traditionally, we have done conservative treatment with bed rest, observation and bracing. However, in some patients these fractures may take weeks to months to heal, and during this time the patient is in pain and is unable to conduct their daily activities. Recently, there are new options which are minimally invasive, and vertebroplasty is one of them. We can inject cement and get the patients up and about in no time.
How is the vertebroplasty procedure performed?
Dr. Maya: It's similar to setting a fracture with a cast, only this time, we put a small needle into the back, into the spine and inject acrylic cement. What that does is it forms a cast inside the spine so the fracture no longer moves, and that prevents pain.
Are the results permanent?
Dr. Maya: It’s a permanent fix for that particular fracture. Keep in mind that those patients are at risk for other fractures down the line.
What parts of the spine do you deal with in vertebroplasty?
Dr. Maya: In the mid and low back there are 12 and five different segments called vertebra, and each of these are at risk for fracture.
What are the risks of the procedure?
Dr. Maya: The procedure is very safe. We do it without general anesthesia -- with a local anesthesia -- and some mild sedation, and it is minimally invasive. The patient has a short hospital stay and the procedure is extremely safe
What kinds of outcomes have you seen?
Dr. Maya: Our patients report to us, and more than 90 percent of the patients have a very favorable outcome with either complete pain relief or significant improvement of the pain.
How common is vertebroplasty?
Dr. Maya: Unfortunately, this procedure is not adopted by many of the general practitioners. Some of them are not aware of it, and others continue to choose the conservative option, which may be indicated in some patients -- but many patients will benefit from this procedure.
Is there any danger to leaving compression fractures untreated?
Dr. Maya: By and large, if the patient has a fracture and is confined to bed -- not moving -- no. But if a patient with a fracture continues to move, there is a danger of further compression and causing nerve damage and spinal cord compression.
How does one prevent a compression fracture?
Dr. Maya: As I said, the number one culprit and enemy is osteoporosis, and that requires early prevention, which includes milk, calcium, diet, healthy lifestyle, and exercise in building up the musculoskeletal system.
What does osteoporosis to do the bones?
Dr. Maya: This has been demonstrated with special techniques and CAT scans, but also manually. You will see that when you do these procedures in patients with osteoporosis, their bones are like butter or mush -- they are very soft, as opposed to a normal person, which is very hard to go through. So there is a significant weakening of the bone. They collapse under their own weight.
Are there tests available to screen for osteoporosis?
Dr. Maya: Yes, there is a test called the DEXA test which measures bone strength, and that’s a quite easy and noninvasive test that can be done on an outpatient basis. It takes 15 minutes and is painless.
What did you do when Nora came to you for treatment?
Dr. Maya: When she came to us, she had a thoracic fracture which she was suffering from. We treated that and she had very good relief. She went home and started her routine, but a couple months after that, she came to us with more symptoms similar to what she had initially. Then we took another MRI and determined that she had a fracture -- a new one -- and we decided to treat that one as well. And she did very well after that.
How is she doing today?
Dr. Maya: Last time I spoke to her, she was pain free and she was doing very well conducting her daily activities. She is an avid shopper I understand, so I’ll let you talk to her.
What do you advise vertebroplasty patients to watch out for?
Dr. Maya: In general, we advise our patients to be very careful with their motions, with the way they walk, the way they sit up or get up, get in and out of cars and carry their weight.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Marcel Maya, MD
Cedars-Sinai Medical Center
S. Mark Taper Foundation Imaging Center
Los Angeles, CA
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Repairing Spinal Fractures, click here.