(Disclaimer: This article is for general use only, and the information in the following content has been processed to protect patient privacy)
Abstract: The patient was admitted to the hospital with lumbar pain, which was aggravated by standing and walking, and the lumbar spine X-ray suggested: lumbar 2 and lumbar 5 compression fractures. The relevant examination was completed and the diagnosis was lumbar compression fracture due to severe osteoporosis. The patient was given vertebroplasty for lumbar 2 and lumbar 5 fractures under local anesthesia, and the patient’s pain was relieved and she was able to move around 24 hours after surgery.
Basic information】Female, 79 years old
Disease Type】Compression fracture of lumbar spine, severe osteoporosis
Hospital】The First People’s Hospital of Jiujiang City
Date of consultation】March 2022
Treatment plan】Surgery (vertebroplasty for lumbar 2 and lumbar 5 fractures) + medication (cefuroxime sodium for injection, alendronate tablets, vitamin D drops)
Treatment period】Inpatient treatment for 2 days, outpatient follow-up for 3 years after surgery
Treatment effect】No significant discomfort and self-care at present
I. Initial consultation
Patient’s self-report: 4 hours before admission, he had back pain when he helped his family lift a table in the yard because of rain, and it worsened when he stood up and walked. At first, he thought he had flashed his back and did not pay attention to it, but after resting, his back pain worsened and he could not sit or stand, and could not turn over by himself. He was admitted to our emergency surgery department by his friends and relatives, and the lumbar spine X-ray showed fractures of lumbar 2 and 5. He was admitted to the orthopedic department for further treatment. Examination: rigidity of the thoracolumbar segment of the spine, pressure pain and percussion pain of the corresponding spinous processes of lumbar 2 and lumbar 5 were obvious, and there was no sensory or motor impairment of both lower limbs.
(Admission lumbar spine x-ray)
II. Treatment history
After admission, the patient underwent lumbar spine MRI, which confirmed that the lumbar 2 and lumbar 5 fractures were fresh fractures. In view of the elderly female with lumbar compression fractures caused by minor external forces, the diagnosis was consistent with lumbar compression fractures caused by severe osteoporosis, and the patient had no symptoms of nerve compression caused by lumbar fractures. According to the guidelines of osteoporotic fracture diagnosis and treatment: it is advisable to consider early surgery in elderly patients, which can effectively shorten the bed rest time and reduce the occurrence of complications. Preoperative preparation was improved, and vertebroplasty of lumbar 2 and 5 fractures was performed under local anesthesia. The patient was positioned prone, fluoroscopically positioned with a C-arm machine, the skin of the operative field was routinely disinfected with iodophor, and lidocaine hydrochloride injection was applied at the puncture site under local anesthesia. After the initial drying of the bone cement, the working sleeve was withdrawn and the puncture eye was closed with absorbable sutures and covered with a sterile dressing. Postoperatively, cefuroxime sodium for injection was given to prevent infection, oral alendronate tablets, regular administration of vitamin D drops and other anti-osteoporosis drugs, and rehabilitation training was guided.
(Magnetic resonance examination of lumbar spine)
III. Treatment effect
After the operation, the patient’s lumbar pain was obviously relieved and he could turn over on his own when he returned to the ward. He walked freely on the ground 24 hours after surgery, and the lumbar 2 and 5 vertebrae were filled with bone cement on the postoperative review X-ray. The patient had no numbness and other discomfort in both lower limbs, and both lower limbs moved freely without obvious discomfort in the ward by themselves. The patient was discharged from the hospital 2 days after the operation and was instructed to follow up the treatment in the orthopedic outpatient clinic, to continue to take vitamin D drops and other anti-osteoporosis drugs regularly, and to perform physical exercise appropriately to improve physical coordination. In summary, the patient was hospitalized for 2 days and followed up in the outpatient clinic for 3 years after surgery. During the follow-up, the patient reported good recovery, no significant discomfort, and could take care of himself.
(Postoperative review)
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but vertebroplasty only treats vertebrae that have been fractured and cannot prevent osteoporotic fractures in other vertebrae; therefore, the patient should continue to take oral anti-osteoporosis medications, such as osteoporotic triol soft capsules and vitamin D drops, for at least 1 year after discharge. In terms of diet, reduce the intake of carbonated drinks as much as possible and eat more calcium-rich fish and shrimp, egg and milk, soy products, etc. Actively participate in outdoor exercises, such as brisk walking, and avoid weight-bearing exercises. Patients are advised to go out in the sun more often, the recommended time is before 10:00 a.m. or after 16:00 p.m., avoiding the strong ultraviolet sunlight at noon. Ensure good lighting and anti-slip measures in the bathroom to prevent falls. Regularly review bone density and seek medical attention if you have back pain.
V. Personal insight
At present, osteoporosis has become a major disease endangering the health of the elderly, epidemiological surveys show that the prevalence of osteoporotic vertebral compression fractures increases with age in China over the age of 50, and the prevalence of elderly women over the age of 80 is more than 1/3. what is more alarming is that the death rate of this disease is about 1/5 and disability up to 1/2, so osteoporosis is called The “silent killer”, causing a huge burden to today’s society. Therefore, prevention of osteoporosis should start at a young age by actively participating in outdoor sports, staying away from bad habits such as smoking, drinking, staying up late and being sedentary, and eating more fish, shrimp, milk and soy products. It is also important to note that if you are too old, avoid lifting overly heavy objects, because the accumulation of osteoporosis over time is very likely to cause compression fractures of the lumbar spine, as in the patient in this case. If a fracture occurs do not panic, seek medical attention and give surgical treatment to help recovery.