Osteoporotic vertebral compression fractures can cause chronic low back pain, changes in morphology and posture, decreased daily activities and increased mortality, making them a serious clinical and social problem.
After a fracture occurs, one-third of the fractures do not heal, resulting in chronic low back pain that remains untreated for a long time. Whenever a fracture occurs in the spine, the incidence of re-fracture of other vertebrae is five times higher than normal. Regardless of whether the fracture heals and is painful or not, multiple vertebral fractures result in altered spinal morphology and can cause long-term chronic low back pain that can seriously affect life, daily activities and health. The impact of osteoporotic vertebral compression fractures on the lives of the elderly is almost equivalent to that caused by a fracture of the femoral neck. According to information, 30% of people who die because of old age suffer from osteoporotic vertebral compression fractures.
How to detect osteoporotic compression fractures in the elderly.
According to the aforementioned characteristics, if elderly people suffer from acute or chronic low back pain or low back pain, regardless of whether they have a history of injury or not, they should think of the existence of vertebral fractures and should go to the hospital promptly for a radiograph or CT examination to exclude vertebral fractures; when ordinary radiographs are not completely sure, it is better to do an MRI examination to make a clear diagnosis.
How to avoid vertebral osteoporotic compression fractures in the elderly.
This is a difficult problem because such fractures are different from general traumatic vertebral fractures, which have an obvious injury; whereas vertebral osteoporotic compression fractures occur due to a decrease in bone density and bone strength, and some patients do not even have a history of trauma.
Therefore, preventing or avoiding vertebral osteoporotic compression fractures in the elderly is quite difficult. But the following suggestions may help.
1. treat and prevent osteoporosis, and do so consistently over time.
2.Provide buildings and roads with barrier-free design for the daily activities of the elderly.
3. Take special care when bathing, as the floor is slippery and prone to stumbling or falling.
4.Avoid violent bumps, sudden starts or sudden brakes when riding in a car.
5.When elderly people do physical exercise, they should do it according to their ability.
6. Reduce body weight.
In a word, always keep in mind that osteoporosis is prone to fracture, and always be careful in order to reduce the incidence of fracture.
Treatment of osteoporotic vertebral compression fractures.
After a vertebral compression fracture occurs due to osteoporosis, different treatment methods can be adopted according to the patient’s condition, including non-surgical treatment methods and surgical treatment methods.
Non-surgical treatment methods.
1. bed rest for a period of 6 to 12 weeks.
2. wearing a special plastic brace, which is usually worn for 3 months
3. taking pain medication.
4. treatment of primary osteoporosis with calcium preparations, injections, hormone replacement therapy for female patients and hormone supplementation therapy for male patients
5, diet therapy and physical therapy, etc.
After such systematic conservative treatment, about 2/3 of patients with low back pain symptoms can disappear, and about 1/3 of patients with chronic low back pain or low back pain need to receive surgical treatment.
It should be noted that methods such as bed rest, immobilization with a lumbar girth or custom-made plastic undershirt, and taking painkillers can also be used by the elderly. However, prolonged bed rest can cause more bone loss; plastic undershirt fixation takes 6 to 12 weeks; long-term painkillers are irritating to the stomach and risk causing stomach hemorrhage, and more importantly, 6 to 12 weeks of conservative treatment should be adhered to. However, 1/3 of these fractures do not heal and have to undergo vertebroplasty again.
Surgical treatment methods.
Elderly people with osteoporotic compression fractures should be treated with vertebroplasty or vertebroplasty for posterior convexity.
Osteoporosis is characterized as a chronic, systemic, progressive disease, and because it occurs mostly in the elderly population, who often have other systemic diseases such as heart disease, hypertension, lung disease, and kidney disease, they are not able to tolerate major surgical trauma. The above two procedures are very less traumatic, take less time, can be performed under local anesthesia, and cause less interference with other systems throughout the body, so most patients can tolerate this surgical operation.
Pedicle screw fixation technique: It is the current method often used to treat vertebral fractures in young people, but it is not suitable for the elderly because the screws used for fixation are easily loosened or pulled out after screwing into the lax vertebral body, and the effect of fixation is not achieved. In vertebroplasty and vertebral body kyphoplasty, the bone cement is injected directly into the fractured vertebral body to strengthen and fix the fracture from the inside, and the bone cement is tightly bonded to the surrounding bone after solidification, so there is no risk of loosening of the fixation and no risk of screw extraction.
Vertebroplasty and vertebral body kyphoplasty.
Vertebroplasty and vertebral body kyphoplasty are effective and have relatively few complications. After treatment with vertebroplasty, patients can be out of bed in 8 to 12 hours, and 90 to 95 percent of pain disappears or is significantly reduced. After observation of a large number of cases, 3 months and 6 months after surgery, both the pain condition, activity condition and quality of life are better than the results of conservative treatment. It has become the main or important treatment for osteoporotic compression fractures in the world.
Currently, new advances have been made in these two techniques, namely, the amount of bone cement to be injected to restore the strength of the vertebral body is scientifically calculated before surgery based on the volume of the diseased vertebral body. This has resulted in a significant reduction in the amount of intraoperative bone cement used compared to the previous technique and has more effectively avoided potential and possible complications, making both techniques even better. Both techniques provide significant pain relief and can also treat primary or metastatic tumors of the vertebral body, thus providing further treatment of the tumor.
Vertebroplasty procedure.
A catheter is placed in the diseased vertebral body by the surgeon under X-ray fluoroscopic guidance through a skin puncture; the bone cement, a specially formulated polyethylene material, is prepared to a semi-liquid state prior to use and they are injected into the diseased vertebral body with a syringe through a pre-placed catheter; the semi-fluid bone cement spreads within the vertebral body along the gaps of the bone defect and solidifies into a solid after 5 to 10 minutes, thereby fracturing the fractured and lax vertebrae are strengthened for the purposes of stabilizing the spine, treating pain and increasing functional activity, and improving quality of life.
Vertebroplasty surgery.
Similar in principle to vertebroplasty, this new technique was first reported in 2001 in the U.S. The difference is that a special small airbag is used to pre-expand the vertebral body into a cavity before injecting the bone cement into it. The goal is to restore the height of the vertebral body, reposition the fracture, and reduce the leakage of cement into the spinal canal, a common complication during vertebroplasty.
Characteristics and results of the application of vertebroplasty surgery and vertebral body kyphoplasty procedures.
In the treatment of fresh type of vertebral compression fractures, posterior convexity molding is superior to vertebroplasty, and posterior convexity molding can be preferred if available (the method is relatively expensive); in the treatment of old compression fractures, the efficacy of the two is similar because the fracture cannot be re-set. There are no major differences between the two in terms of operation time, preoperative preparation, postoperative rehabilitation and care, and treatment outcome.