Bound & gagged girls. VERTEBRAL AUGMENTATION: COMPLICATIONS & TROUBLESHOOTING- Dr Neeraj Jain MD, FI

VERTEBRAL AUGMENTATION: COMPLICATIONS & TROUBLESHOOTING- Dr Neeraj Jain MBBS, MD, FIMSA, CIPS (Hungary), FIPP (USA)
09810033880. managepain@yahoo.com, drmanagepain@gmail.com
Senior Consultant Spine & Pain Specialist,
Spine & Pain Clinics
Sri Balaji Action Medical Institute & Action Cancer Hospital
In-charge Spine & Pain Clinic, MDCITYHospital, Model Town New Delhi.
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A NOVEL APPROACH TO MANAGEMENT OF VERTEBRAL BODY FRACTURES:
As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Kyphoplasty has the added advantage of addressing fracture with spinal deformity and
appears to be associated with fewer instances of bone cement extravasations As per Greek mythology pain was thought to be due to intrusion of particles into soul, now pain relief is done by intrusion of particles into bone. The bone of content is to fill bone with content. In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of
management in place of painful conservatism or major spinal surgery with a list of complications in polytrauma settings for painful uncomplicated VB #; especially when the spine surgery is relatively complicated or patient refuses due to surgery phobia or cost involved or there may be comorbid conditions /injuries deterrent for surgery. PVP is a big help in polytrauma setting when stabilizing spine does lot of good to the patient’s overall management
INDICATIONS
Senile osteoporotic compression # remains the commonest Indication (83%). In fact, one in four women over 50 will suffer an osteoporosis related spinal fracture. Even more startling, spinal fractures are twice as likely as hip fractures. And they’re three times more common than breast cancer. Yet as many as two-thirds of spinal fractures go untreated.
Painful new or progressive osteoporotic collapse # refractory to medical therapy or dosage of analgesia leads tounacceptable side effects.
Complicating Co-morbid diseases, on steroids & received transplant.
To reduce loss of vertebral height and possibility of continued collapse
Metastatic VB #, Multiple Myeloma VB # (3%). Approximately 30% of patients with various neoplastic conditions develop symptomatic spinal metastases during the course of their illness & pain is the presenting complaint in the majority of cases.
Aggressive painful VB haemangioma
Vertebral osteonecrosis
strengthening VB before major spinal surgery.
The benefit has been extended to the traumatic uncomplicated VB
compression # (VCF) (14%) which is commoner in younger age
group with active life profile and prime of their career where strict
bed rest and acute or chronic pain are unacceptable and they are
more demanding for proactive treatment approach so as to be back
to work ASAP.
CONCLUSION
With rich experience in osteoporotic PVP one can comfortably pass the benefit to traumatic # where -it is more rewarding & satisfying.
With PVP you just don’t manage pain rather you treat it. It is also important to remember to address the underlying condition of osteoporosis. Improve patients bone health and reduce risk for future fractures through a combination of medication, diet, exercise and lifestyle modifications.
Very few people die of pain, many die in pain and even more live in pain, some of them are sequel to spine traumatic fractures, a reversible suffering.
We have to keep pace with patients needs.
PVP may be is the future of uncomplicated VCF management.
kyphoplasty has the added advantage of addressing spinal deformity and appears to be associated with fewer instances of bone cement extravasation.
Pain means punishment, we can avoid the chronic punishment of VCF with PVP avoiding all D’s of disability, depression, drugs dependence, deformity, dissociation & dejection.
In future we are looking for high radiopaque biodegradable or bioactive bone pastes or cement or glues with more procedural time relaxation which will strengthen the bone while inducing new bone growth.
Vertebroplasty is a viable treatment and possible standard management of the pain and disability of vertebral fractures needing INTERVENTION