Treatment of spine fractures in osteoporosis or neoplasm

Osteoporosis is a condition whose first manifestation is often a spine compression fracture. The injury is very painful. The treatment involves the stabilization of the fractured section with a back corset and pain medication. Vertebroplasty and kyphoplasty are optional procedures. During these procedures cement is injected into the spine. This stabilizes the fracture and alleviates pain.

• pain is quickly reduced,
• biopsy can be performed during the procedure.

• The patient’s eligibility is evaluated on the basis of the whole clinical picture.
• Diagnostic imaging is necessary: the standard test is a 1.5 or 3-tesla MRI scan. If there are absolute contraindications for an MRI scan (strong claustrophobia, metal implants, others), the patient’s eligibility may be evaluated on the basis of an ‘open’, low-field MRI or computed tomography.
• If there are doubts as to the continuity of the wall between the vertebral body and the spinal canal, a computed tomography examination is recommended in addition to an MRI scan.

The basic laboratory tests include blood type and Rh factor, complete blood count, basic biochemistry tests (sodium, potassium, urea, creatinine, glucose), coagulation parameters (APTT, INR), ECG, a general chest x-ray (for patients over 40 or with a history of pulmonological problems). Additional tests or consultations with specialists may be required, depending on the patient’s condition, the underlying disease and other medical conditions (such as a thyroid profile test, urinalysis, consultation with a cardiologist). The meeting with the anaesthetist takes place a few days before the procedure if the neurosurgeon so recommended. Otherwise, the meeting takes place on the day of the procedure, during the admission process.
Please bring to the hospital only the necessary items, such as medical records, neurosurgeon’s consultation documents with the eligibility evaluation, imaging test results (MRI, CT, x-ray) on CDs with descriptions, laboratory test results, routine medications, toiletries, towel, socks, pyjamas and footwear as well as a change of clothes. Please do not bring any jewellery and other valuables. In each hospital room there is a wardrobe and a cupboard for your personal belongings (in two-person rooms each patient has his/her own wardrobe and cupboard).
The final evaluation of your eligibility for the procedure is done on the day of the procedure. You will be asked to give written consent to the surgical procedure and general anaesthesia (you can download samples from our site). You will also take blood pressure medications, heart medications and hormonal medications if you take them on a regular basis.

The surgery is usually performed under general anaesthesia. A needle is inserted into the fractured vertebral body under x-ray guidance. The procedure usually lasts about 30 minutes.  Subcuticular suturing is used.

After the procedure you wake up at the recovery room next to the operating theatre. Following your full awakening from anaesthesia you will be transferred either to your room or the recovery room (depending on your condition and the course of anaesthesia/procedure).
After 4-5 hours we make the first attempt to mobilise you (with a nurse’s or a doctor’s assistance). On the day of the procedure you may walk around your room and go to the bathroom. Activity is slightly limited. During that time you will be wearing a corset brace (you must bring it with you to hospital). On the day after the procedure you get up in the morning and increase your activity level. Before midday you should be able to walk in the corridor or balcony. During that time you will receive advice on post-operative rehabilitation from a qualified physiotherapist. You will be discharged in the afternoon, after a medical examination.
While at home you should avoid effort for 2 to 3 weeks. During this period you should avoid straining your spine, lifting, bending, and rotating movements as well as other activities which involve dynamic torso movements. In the first week after the surgery you should schedule a follow-up appointment to check your wound. The next visit is scheduled 3 weeks after the procedure to evaluate preliminary treatment outcomes. During the whole post-operative period you can call your doctor directly.