Osteoporotic Fracture- presentation • Sudden onset pain in thoracic or lumbar spine • Minor trauma • Sometimes there is no trauma • A T10 fracture can cause pain in the lower lumbar spine- so palpate the whole spine • A wedge fracture on xray may be tumour or an osteoporotic fracture- so an MRI scan is essential
Osteoporotic Fracture- presentation. Sudden onset pain in thoracic or lumbar spine Minor trauma Sometimes there is no trauma A T10 fracture can cause pain in the lower lumbar spine- so palpate the whole spine - PowerPoint PPT Presentation
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Osteoporotic Fracture- presentation
• Sudden onset pain in thoracic or lumbar spine• Minor trauma• Sometimes there is no trauma• A T10 fracture can cause pain in the lower
lumbar spine- so palpate the whole spine• A wedge fracture on xray may be tumour or an
osteoporotic fracture- so an MRI scan is essential
Management• Blood tests: ESR, CRP, Bone
Chemistry, Serum Electrophoresis, Renal and Thyroid function, Vitamin D levels.
• Rule out secondary causes and tumours
• MRI scan and Xray• Consider a Bone Density Scan• Advise rest and pain killers• If pain not settling in 6 weeks
refer to spinal unit
COMMON SECONDARY CAUSES OF OSTEOPOROSIS• Renal problems• Diabetes• Thyroid dysfunction• Early menopause• Steroid usage• Drugs for Epilepsy• Parathyroid dysfunction
Epidemiology
300,000 hip fractures/yr USA.700,000 spinal fractures/yr.1/3 new, 2/3 old.14 bed days/fracture.20% collapse can progress to 70%
collapse.Sex: 75% women .At 80 same incidence as men.
Problems after Vertebral fractures• Transient Ileus• Urinary retention• Pain• Problems with
function• Increased mortality0.5% risk of paraplegia
23% increased mortality in women > 65years with Vertebral Compression Fractures compared with age matched controls.
KADO et al. Arch Intern med. 1999
9% reduction in Forced vital capacity per thoracic compression fracture
Vertebroplasty- Bone Cement injection into vertebral body
• Originated in France – 1986• 70-90% pain relief• 1-6% risk of complications
How does Vertebroplasty work?
• Reduced micro-motion and restoration of load transmission
NEEDLES PLACED IN VERTEBRAL BODY UNDER XRAY CONTROL
NEEDLES PLACED IN THE VERTERAL BODY UNDER XRAY CONTROL
BONE CEMENT BEING INJECTED INTO VERTEBRAL BODY
XRAY MONITORING OF CEMENT PLACEMENT THROUGHOUT
AP XRAY OF CEMENT IN THE VERTEBRAL BODY
F= 67. 6 year H/o back pain- 90% better after the procedure
Results
• Significant pain relief is seen in 75-90% of osteoporotic fractures
• And in 59-86% of malignant fractures.• Increased mobility• Reduced analgesic requirement• Results are sustained over time• Complication rates are low and include