Mom is in a lot of pain right now from a vertebral compression fracture in the middle of her back. We've been told she could have a fairly simple surgery called vertebroplasty that would put some cement in there and help with the pain. But it's expensive and the results won't be any different than if she wears a brace and waits six weeks. Is it right to let her suffer when something could be done?
The ethical dilemmas of choosing one treatment over another while weighing out the pros and cons of time, pain, suffering, and end-result can be very difficult. Patients and physicians face this every day.
With a vertebral compression fracture (VCF), we know that the bone has collapsed because of weakness. The underlying cause could be osteoporosis (brittle bones), tumor, or some other disease process that affects bone strength.
Conservative care is usually the first line of treatment offered or suggested. It is safe, effective, and low-cost (compared to surgery). For patients in acute pain and in danger of lung compromise, vertebroplasty is a procedure that can provide immediate pain relief. Up to 95 percent of patients get pain relief quickly with this treatment. The vertebroplasty restores spinal stiffness and increases spine strength needed for pain free stability.
But complications such as fever and cement leaking out have been reported. The oozing cement can put pressure on the spinal cord or nearby nerves or even travel to the lungs as a cement clot (embolism). There have been some studies showing that patients can develop other fractures in the adjacent vertebrae. But whether these new fractures are a result of the osteoporosis that caused the first vertebral compression fractures or perhaps the result of the vertebroplasty is unknown.
Long-term studies now available show that the results from the vertebroplasty don't last. And recovery is about the same when compared with patients who were treated conservatively with physical therapy, postural exercises, and pain relievers. The main difference is how quickly pain relief is delivered: immediately with vertebroplasty versus two to four weeks later with nonoperative care.
If your mother is suffering from compromise to the lungs so that breathing is a problem, it may be worth it to take a second look at vertebroplasty. But talk with her surgeon first and get all the facts. The decision may be one that really has a clear conclusion right from the start when all the factors are weighed in.
Vishal C. Patel and Franco P. Cerabona, MD. The Role of Vertebroplasty and Kyphoplasty for the Treatment of Osteoporotic Compression Fractures. In Current Orthopaedic Practice. July/August 2010. Vol. 21. No. 4. Pp. 375-377.