Spinal Compression Fracture: A Silent Epidemic By Avery M. Jackson, MD, FACS, FAANS During my complex spine fellowship at the Medical College of Wisconsin in 2000, we worked with cadaver spines in which we created compression fractures, fixed them, and then examined how the biomechanics of our treatment restored the spine. These experiments were intriguing, to say the least. It was exciting to feel a kinship with physicians of bygone eras who learned of new, more effective treatments and were eager to help patients with them, even while skeptical colleagues stuck to conventional treatments. We and the American public fully understand the serious threat that a hip fracture— suffered by 300,000 citizens annually—poses to a patient’s mortality. Yet, far less recognized is the equally serious threat to the patient’s quality and length of life caused by spinal fractures. Though some 700,000 Americans suffer spinal compression fractures each year (making them more than twice as common as hip fractures), only 15 to 20 percent of them are treated. More than a shame—in my opinion it’s downright shameful—that our society allows this silent epidemic of compression fractures to continue when proven procedures are available to relieve patients’ pain and reduce their chances of premature death. Having personally performed these procedures hundreds of times over, I’ve witnessed the vast improvements in quality and length of life firsthand. But don’t just take my word for it. I encourage you to visit our website at www.MichNeurosurgical.com. There, you’ll find a video by Dr. Robert James, a retired family practitioner from Flint, explaining in his own words how his mobility was restored through kyphoplasty—a minimally invasive procedure to treat vertebral compression fractures that can be done on an outpatient basis. Now 86, Dr. James had been diagnosed several years ago with the autoimmune disorder polymyalgia rheumatica. He was treated with a low dose of prednisone, which can lead to osteoporosis, and evidently it did. Later on, while recovering from an illness with multiple complications, Dr. James began to experience terrible back pain. An X-ray was negative. Here’s part of what he says in the video: “They kept telling me I’m all right—it’s just a little back pain and it will go away. They always ask you [your level of pain], ‘Is it 1 to 10?’ It was 10-plus. You’re really incapacitated. You can’t get out of bed. It was like putting me in prison. It’s a terrible way to live.”
Dr. James, who’d never had a backache before, insisted on an MRI. It showed a vertebral compression fracture. Because of this medical experience, he knew it typically takes two or three weeks from the time a compression fracture occurs until it reveals itself on an X-ray or MRI. He’d heard about kyphoplasty from his colleagues and son, so he called my office and made an appointment with me. He couldn’t walk into the office for the procedure. Simple movements caused him great pain. After the procedure was done, it was gratifying to see that he wasn’t grimacing in discomfort when we sat him up. But let him tell you how he felt: “It was just like a miracle. To have all that pain resolve itself over a short period of time, and you’re up again, walking and doing normal things—it’s marvelous.” Like me, Dr. James is baffled by the naysayers who question the effectiveness of kyphoplasty, and also vertebroplasty, for the treatment of vertebral body compression fractures.
Kyphoplasty: Patient Selection Criteria •••
Patient age 50 or older Pain to Percussion Pain (due to fracture) less than one year old MRI or Bone Scan shows an active fracture
“I was on home nursing care about six weeks and that’s very expensive. It’s tough for the system to bear that kind of burden. To know this procedure is available—that you can get a patient up walking on their own two feet and taking care of themselves—and then not utilize it, makes me sad. It’s a great procedure.” Dr. James is a firm believer in an old principle of medicine: If you get the right treatment, for the right disease, good things happen. He’s living proof. If you’d like to know more about kyphoplasty—or if one of your patients might qualify—please don’t hesitate to call on me as a resource. And I hope you’ll take a moment to visit the MNI website to hear Dr. James talk about how the quality of his life has improved.
Avery M. Jackson III, MD., FACS, FAANS, is the chief executive officer and medical director of Michigan Neurosurgical Institute, P.C., which he founded in 2003. A board-certified neurosurgeon, Dr. Jackson has extensive training and experience in complex spinal cases, brain and spinal tumors, head and spine trauma, as well as minimally invasive procedures such as vertebroplasty and kyphoplasty.
Published on Jan 23, 2014