Spinal Injections of Cement Strengthen Broken Backs

Liquid cement injected into the fractured vertebrae of osteoporosis sufferers can reduce pain and limit disfigurement caused by the degenerative bone disease, researchers said.

The treatment is one of only a few available to osteoporosis patients for compression fractures of the spine--other than extended bed rest, said Dr. Gregg Zoarski, lead author of the study by the University of Maryland.

“I think this is going to become standard care for patients who have pain from compression fractures,” Zoarski said.

Zoarski, director of Diagnostic and Interventional Neuroradiology at the University of Maryland Medical Center, and his colleagues followed 30 patients treated with the procedure, known as vertebroplasty, for six months.

Using X-ray imaging as a guide, doctors insert a long needle directly into the damaged vertebra. The quick-setting cement, which has the consistency of wet cake frosting, is then pushed through the needle into the bone.

The procedure is typically done on an outpatient basis, and patients are commonly allowed to go home two to three hours after it is performed.

Eighty percent of the patients studied said they experienced significant pain relief after two weeks. Their responses were compared to the answers they gave on the same questionnaire before the procedure was performed.

“We’ve kind of reached a critical mass where there is enough science that has been done on this that it is really igniting among doctors nationwide,” said Zoarski, who presented the findings on March 28 to the 25th annual meeting of the Society of Cardiovascular and Interventional Radiology in San Diego.

Ten million Americans have osteoporosis, a disease characterized by deterioration of the bone that can lead to fragility and an increased risk of fractures, according to the National Osteoporosis Foundation. The disease is blamed for 700,000 vertebral fractures annually.

Vertebroplasty procedures have been performed in the United States for only about two years but have been used by doctors in France for more than a decade, said Dr. Kent Thielen of the Mayo Clinic, who has performed the procedure for the last year.

The cement has been used for many years to patch hip fractures and to repair other bones. The substance has already been approved by the Food and Drug Administration, Thielen said.

Patients have to be carefully selected for the injections, Thielen said.

Only those who are in severe pain, localized to the area of the compression fracture, are eligible for the injections at the Mayo Clinic. That translates to only one out of every seven patients he sees, Thielen said.

For those who do fit the criteria, the success rates with the injections are high.

“The beauty of this procedure is that it seems to be successful where there was nothing else for these patients before,” Thielen said.

Zoarski and Thielen said they have found no significant long-term problems or side effects from vertebroplasty. But neither has been able to follow patients for more than a year since the procedure is relatively new, they said.

Jack Devine, 69, who suffered a fractured vertebra due to melanoma, said he was able to stand several hours after he had the injection.

He had been restricted to bed rest for more than a week with the fracture, and was in so much pain that he had to be taken to the University of Maryland Medical Center in an ambulance.

“Right after the operation I felt 100% better,” he said late last month as he waited to be released from the hospital. “I’m a real active guy--a skier, a runner and a boater. To be laid low like that was difficult.”

It is that apparent high and rapid success rate that Zoarski says makes the procedure so valuable.

“This is the kind of thing where you get these little old ladies who are up for the first time in weeks,” he said. “They want to hug you and send you cookies in the mail.”