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Cement Injections Ease Pain of Fractured Vertebrae

Cement Injections Ease Pain of Fractured Vertebrae

October 26, 2001 By Merritt McKinney

NEW YORK (Reuters Health) - Spinal injections of acrylic cement can reduce the pain of fractured vertebrae without surgery, according to the results of a study.

The study's authors suggest that it may be possible to stave off some fractures by injecting the cement into damaged vertebrae that have not yet collapsed.

Vertebral fractures, which are usually caused by the brittle-bone disease osteoporosis, affect up to 700,000 Americans each year. Even after treatment--such as bed rest, pain-killing medications and bracing of the fracture--many patients experience considerable pain.

Originally performed during surgery, acrylic cement injections can now be given through the skin, or percutaneously, to bolster collapsed vertebrae, the researchers report. During the procedure, a surgeon relies on x-ray images as a guide to inject cement into the appropriate areas of vertebrae.

To determine the safety and effectiveness of the procedure, Dr. Arun Paul Amar and colleagues at the University of Southern California in Los Angeles reviewed the cases of 97 mostly elderly patients who underwent cement injections. Before having the injections, all of the patients had disabling back pain or trouble moving around that persisted after conventional treatment.

Two weeks after the injections, many patients experienced substantial improvements, according to the report in the November issue of the journal Neurosurgery.

Nearly two out of three patients needed less pain-killing medication after treatment. A little more than half of patients were able to move around better afterwards, and half had less trouble sleeping.

Nearly three out of four patients said that their quality of life had improved significantly after the injections, the report indicates.

Several patients had relapses of pain, however. Many of these patients, Amar's team explains, had developed new fractures and underwent additional injections.

Besides these patients, none of the patients who had improved after the treatment experienced a worsening of symptoms up to 35 months later.

The treatment appeared safe overall, but in several patients the cement was not confined to the damaged vertebrae. Three patients developed a pulmonary embolism--a potentially fatal blockage in the lung--made of the acrylic cement. Two of these patients did not have symptoms, but one was short of breath and developed temporary swelling in the lungs after treatment.

In several other cases, the cement spread beyond the confines of the fractured vertebrae. In the case of one patient who continued to have pain after treatment, surgery to remove the extra fragments of cement relieved the pain.

Overall, injecting acrylic cement is an effective and safe treatment for patients with so-called compression fractures in the spine, Amar and his colleagues conclude. Currently, the technique is only used to relieve pain, but it may be able to prevent fracture by strengthening weakened vertebrae that are at risk of breaking, the authors suggest.

SOURCE: Neurosurgery 2001;49:1105-1115.

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