Osteoporosis is a condition wherein the bones become brittle and weak; so much so that even mildly stressful activities such as coughing, bending over or even a slight fall (such as the one from a high rise chair) can result in fractures. Osteoporosis-related fractures commonly occur in the spine, hip or the wrist. The human body has a continuous mechanism of bone absorption and removal. In case of osteoporosis, the creation of new bones doesn t happen in accordance with the removal of old bones.

Spinal Fractures:

The bones of the spine get extremely vulnerable to breakage and even cracking open. The fractures in the spine, also known as vertebral compression fractures can cause a sharp stinging pain in the back that may make sitting, standing, or even walking a very tardy task.

Risk Factors:

Increasing age

Abnormally less or high body weight

Smoking

Menopause or low levels of sex hormones

Gender: This disorder is more likely to affect women as compared to men. Also women, who are above 50 are more likely to suffer from this debilitating disorder.

Race is a significant risk factor of osteoporosis. If you are of Asian descent, you are more likely to be affected by it.

Having a family history of osteoporosis will put you at a greater risk of this disorder.

Symptoms:

Fractured or collapsed vertebra causing back pain

A stooped posture

A shrunken appearance (as if one has had loss of height)

Very fragile bones, thus increasing risks of fractures

Severe and sudden pain in the back

Difficulty in twisting or bending the body

Lower spine fractures are way more troublesome as compared to fractures in the upper spine. Fracturing more than a bone in the spine also remains a huge possibility.

Diagnosis and Treatment:

Firstly, an X-ray or a computerized tomography (CT scan) will be done to have a closer look at the bones. A bone density test is another commonly used method of diagnosing osteoporosis. 

Steroids and medications: Some medications may be used to prevent or combat osteoporosis. These include alendronate, ibandronate, risedronate and zoledronic acid.

Physical therapy: Just like muscles, bones get stronger too when you exercise. Weight-bearing and muscle- strengthening exercises are the most helpful in this regard and are considered best for the treatment of osteoporosis. Cardiovascular exercises such as walking, jogging or even swimming can prove to be immensely beneficial.

Diet: Make a diet chart that includes high-calcium food items, dairy products such as yogurt, cheese, and low-fat milk, tofu, green vegetables such as collard greens and broccoli, sea fish such as salmon and sardines.

Salt: Limit salt intake

Therapy: Hormone replacement therapy (treatment method consisting of estrogens to alleviate and treat symptoms of osteoporosis) is another method of treatment that can be recommended by the doctor.

Osteoporosis Spine Fractures: Risks, Symptoms and Treatments

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.

Morbidity & consequences of spinal fracture:

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc element
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Results / Outcome

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are Metastatic VB, Multiple myeloma VB, VB haemangioma, Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF) 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.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis. Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient back to normal life.

In this era of MAS 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.

Morbidity & consequenses of spinal 

Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
High risk of primary or consequential damage to neural, bony or disc elements.
Increased wedging, deformity & increase incidence of adjacent VB
Chronic pain of altered spine mechanics.
Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
Morbidity and complication of spinal surgery 

Cost of surgery and hospital treatment
Cost of implants
Phobia of surgery
Prolonged recovery period & Extensive rehabilitation
Changed spinal mechanics & transition syndrome
Major surgery & anesthesia with its own complications
Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

Cementing of fragments.
Thermal neurolysis of VB nerve ending due to heat of polymerization.
Washing away of nociceptor chemicals.
Neurolytic action of liquid monomer.
By allowing early ambulation decreasing pains of immobility & bed rest.
Complications 

PVP is generally safe with low risk.
Ectopic cement leak is frequent but generally inconsequential.
Outcome 

PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
Different studies show an immediate pain relief in (85   90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
PVP does augment height of VB but ideal would be kyphoplasty.
Patient is either off medicine or on reduced doses.
Patient feels so well that he almost forgets if he had VB

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

Osteoporosis is a degenerative condition connected with the bones. In this condition, the bones become absolutely brittle and hollow over a period of time. In normal scenarios, bones usually get broken down and repaired over time. They are known as the living tissue of the body. But when the old bone does not get removed due to the lack of new bone creation, this is known as osteoporosis. This disease can affect both men and women. Many women go through this condition after menopause. Let us find out more about the symptoms of this condition.

Causes: There are a variety of things that cause the painful symptoms of osteoporosis. Hormonal changes that affect the sex and thyroid hormones as well as adrenal and parathyroid glands are known to cause this condition. Also, low calcium intake over a prolonged period, especially after childbirth and during menopause can cause this condition in many women. Further, eating disorders where the patient practices severe restrictions when it comes to food intake, can also have a bearing on the person, which keeps the right nutrients from reaching the bones. Steroids and other kinds of medicines that have been used on a prolonged basis in order to treat cancer, gastric reflux, seizures and to cure transplant rejections, can also lead to this condition. Celiac disease, lupus, rheumatoid arthritis, inflammatory bowel conditions and liver or kidney disease can also lead to osteoporosis.

Fracture: One of the most common symptoms of osteoporosis includes fragile bones that may lead to fractures. Even a minor movement or a fall can cause a fracture as the bones are brittle and hollow. Because the bones are more delicate than usual, these fractures can be triggered easily by an impactful action like a particularly loud sneeze or a persistent cough.
Neck and Back Pain: Compression fractures in the spine are a common occurrence for people who are suffering from osteoporosis. The vertebrae that have collapsed can pinch the nerves radiating from the spinal cord. This can be a very painful condition that goes from tender pain to debilitating sharp pain.
Height: One of the most noticeable symptoms of osteoporosis includes the visible loss of height. A patient suffering from this condition will appear to have shrunk suddenly, in a very mild way. It can cause a condition known as kyphosis, which is basically a stooped back. Owing to this condition, there may be severe pain in the neck and lumbar, or lower back region as well.
Emergency Situation: If you happen to be experiencing debilitating and sudden pain in the hip or wrists or other such areas, then it is recommended to see a doctor immediately as this could indicate a fracture.

Osteoporosis - 4 Common Signs!

Osteoporosis is a bone disease that happens when bone density decreases and the body stops producing as much bone as it did before. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps. It can affect both males and females but it is most likely to occur in women after menopause, because of a sudden decrease in estrogen, the hormone that usually protects against osteoporosis.

Symptoms of Osteoporosis-

The early stages of osteoporosis do not cause any symptoms or warning signs. In most cases, people with osteoporosis do not know that they have the condition until they have a fracture. If symptoms do appear, some of the earliest ones may include receding gums, weakened grip strength, weak and brittle nails, back pain, loss of height over time, a stooped posture, and a bone fracture that occurs much more easily than expected.

Causes of Osteoporosis-
Some of the leading reasons behind osteoporosis include the following:

Age: The biggest cause of osteoporosis is age. It mostly affects people aged above 50.
Menopause: Another primary cause of osteoporosis in women, which occurs around the age of 45 to 55 years. Due to the changes in hormone levels associated with it, menopause can cause a woman s body to lose bone even more quickly.
Reduced sex hormones: Lower estrogen levels appear to make it harder for the bone to reproduce.
Ethnicity: White people and Asians are more susceptible than other ethnic groups.
Bone structure: Being tall or slim increases the risk of osteoporosis.
Vitamin D deficiency: In case of vitamin D deficiency, the body cannot absorb adequate amounts of calcium from the diet to prevent osteoporosis.
Risk Factors for Osteoporosis-
A number of factors can increase the likelihood of osteoporosis, these may include your age, race, lifestyle choices, and medical condition and its associated treatment. Some of the risk factors for osteoporosis are out of your control, including sex, age, race, family history, and body frame size. Osteoporosis is more common in people who have too much or little of certain hormones in their bodies. Examples include sex hormones, thyroid hormones, and hormones released by the adrenal glands. Osteoporosis is more likely to occur in people who have low calcium intake, eating disorder, and gastrointestinal surgery. Osteoporosis has also been associated with medications used to combat or prevent seizures, gastric reflux, cancer, and transplant rejection. Even lifestyle choices such as sedentary lifestyle, excessive alcohol consumption, and tobacco use can increase your risk of osteoporosis.

Prevention of Osteoporosis-
There are many risk factors for osteoporosis that you cannot control. These include being female, getting older, and having a family history of osteoporosis. There are some of the factors, however, that does fall within your control. Some of these ways to control osteoporosis include getting plenty of vitamin D and calcium, doing weight-bearing exercises, abstinence from smoking and for women, weighing the pros and cons of hormone therapy. If you are at an increased risk of osteoporosis, talk to your doctor about the best way to prevent it and do that as early as possible.

Osteoporosis - Symptoms You Must Not Ignore!

Our bones and joints make us functional on a day to day basis. It is, therefore, imperative that we should take good care of them at all times. There are many conditions that can affect our skeletal system and one of them is, Gout. While the link between the two may not be that obvious, gout happens to be a condition, which is sometimes related to arthritis. Therefore, it is sometimes known by the name 'gouty arthritis'.

While the issue may be severely painful, it does not mean that it cannot be reduced. And of course, when a person has the option and cutting the pain caused by gout drastically, his or her natural response is likely to be 'why not?'

Why Does It Happen?

The main reason for the occurrence of gout is too much uric acid being present in the body. The limbs of the body swell up, especially the extremities and this is known to be very painful. In many cases of gout, the swelling is especially evident in the big toe. Flare ups can last hours on end and may even get longer.

The people who wish to get the gout that is putting him or her through so much pain treated, there are quite a few options at their disposal. There are pain relievers that can be consumed under the advice of a medically qualified professional. While these pain relievers do not treat gout, but can reduces the intensity of the symptoms. Daily doses can be recommended as per the requirement and severity of the situation.

How to Get Rid of Gout?

While some anti-inflammatory drugs may have their effect, but no matter how bad the pain, aspirin is a drug that needs to be avoided. Intake of aspirin can make the problem even worse, which is the last thing a person would want!

The severe problems of gout can be dealt with the chemicals known as corticosteroids. Now, while these can provide some very effective pain relief, using them can be tricky due to certain side effects. One of these side effects is that since these chemicals are injected into the joints, they can significantly weaken them. The other side effect is that they slow the healing process of the wound. Both of these side effects are highly undesirable for any patients. These chemicals are usually prescribed by the doctors after a thorough analysis of patient's condition and history.

A person who drinks alcohol and suffers from severe condition of gout should look to scale back the amount which is consumed by him or her. This is because alcohol increases the amount of uric acid which is present in the blood.

Gout and Its Treatments

People with spine problems face tough choices when considering treatment. Depending on the severity and scale of the disorder, you will have to decide which treatment works the best for you, and keep an eye out for its long-term impact. Owing to the numerous myths and misconceptions surrounding spine surgery, many patients are unreasonably reluctant to consider this as a treatment option.
Before you make your mind, learn the truth behind these myths about spine surgery. 

  Myth: Spine surgery invariably leads to paralysis

Fact: With the introduction of modern technology in the field of medical science, the efficacy and success rates of spine surgery has improved significantly. The chances of paralysis following surgery are less than 1%. Latest advancements in operating techniques have made the procedure safer and more effective than before.

  Myth: You might require multiple surgeries following spine surgery in the future

Fact: In over 90% of all cases, one successful spine surgery at the right time is all you need to treat the disorder. Majority of patients can do without a second surgery. However, it is essential that patients follow all the instructions and preventive measures to make the surgery successful. The post-treatment guidelines include simple things, such as   eating healthy, reducing and maintaining body weight, exercising regularly, quitting tobacco etc. In rare cases, failing to keep up with these instructions may lead to the need for a second surgery.

  Myth: Spine surgeries are painful

Fact: This was once true when open spine surgeries requiring long incisions were performed   but not anymore. Spine surgeries are now relatively painless as compared to earlier times   all thanks to technological advancements. The modern-day minimally invasive procedure has made spine surgery less painful with no or minimal complications, as you need not go under the knife, literally. In fact, patients do not require anaesthesia before opting for the procedure.

  Myth: You will be bed-ridden for life after the surgery

Fact: The common belief among people is that they will never be able to walk again after spine surgery. But that is not true. With minimally invasive techniques and keyhole surgery, the patient is able to walk the very same day of the surgery. In most cases, they are discharged in a few hours following the procedure. Moreover, pain management techniques and physiotherapy have made it easier for patients to move about without much difficulty.

  Myth: The complication rates are very high in the case of surgery

Fact: With advancements in technology, the overall rates of complications have reduced drastically   less than 3% precisely. The state-of-the-art neuro-monitoring system monitors every nerve during the surgery and allows no scope for error. Surgeons have reportedly been able to avoid all nerve-related complications and offer a 100% success rate using this technique.
The decision to undergo spine surgery can be difficult and the misconceptions floating around do not make it easier. Nevertheless, distinguishing the facts from myths is important. Be sure to discuss any concerns or questions you may have with your physician. They can clear your doubts and help you find out if surgery is the appropriate approach to treat your condition.

Myths About Spine Surgery - Debunked!

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