the Success Rate of Vertebroplasty in Elderly Patients

Is the bone cement injection procedure guaranteed to be successful?

I would like to ask if vertebroplasty surgery is guaranteed to be successful? My 91-year-old grandmother suffered from a compression fracture of the first thoracic vertebra due to osteoporosis, causing her significant pain.
She was referred to an orthopedic department at a medical center in northern Taiwan, where she was diagnosed with osteoporosis.
They recommended vertebroplasty, considering it a minor procedure, and we agreed.
However, a month later, her pain has not improved as they suggested; she still experiences sharp pain that has even spread to her lower back and buttocks.
She is unable to sit for long periods and must often lie down.
Her mood has been quite depressed.
Before her follow-up appointment, she relied on pain medications and anti-inflammatory injections.
Today, during her follow-up on October 3rd, we informed the attending physician about her current condition, but he told us that the only option now is to continue taking pain medications.
Is this really the only option?
P.S.
The X-ray showed some leakage of the bone cement.
I would like to ask:
1.
Does this outcome indicate a failed surgery? Is vertebroplasty not always successful?
2.
What other options do we have as family members?
3.
What can be done to alleviate my grandmother's pain? Would heat therapy or electrical stimulation be helpful? Thank you.

dori, 30~39 year old female. Ask Date: 2005/10/03

Dr. Shi Guozheng reply Orthopedics

No surgical procedure or treatment can guarantee 100% success.
For patients with vertebral fractures treated with vertebroplasty, some may experience improvement while others may have limited benefits.
Traditionally, vertebral fractures caused by osteoporosis are primarily managed with conservative treatment, which includes medication, rehabilitation, and the use of a brace for support, all of which can be effective.
Typically, recovery occurs within two to three months.

Reply Date: 2005/10/03

More Info

Vertebroplasty, a minimally invasive procedure used to treat vertebral compression fractures, particularly in elderly patients with osteoporosis, has garnered attention for its potential to alleviate pain and restore mobility. However, as with any medical intervention, its success is not guaranteed, and outcomes can vary significantly among patients.

Understanding the Success Rate of Vertebroplasty
1. Success Rate and Expectations: The success rate of vertebroplasty generally ranges from 70% to 90% in terms of pain relief. However, this does not mean that every patient will experience complete relief. Factors such as the patient's overall health, the severity of the fracture, and the presence of underlying conditions can influence outcomes. In your grandmother's case, the persistence of pain after the procedure may indicate that the fracture was more complex or that other issues, such as adjacent vertebral fractures or underlying spinal conditions, are contributing to her discomfort.

2. Possible Reasons for Continued Pain: The fact that your grandmother is still experiencing pain, particularly radiating to other areas, could suggest several possibilities:
- Incomplete Fracture Stabilization: If the cement used in the procedure has leaked (as you mentioned), it may not have adequately stabilized the vertebra, leading to ongoing pain.

- Adjacent Segment Disease: The stress on adjacent vertebrae can lead to new fractures or degeneration, which may cause pain.

- Other Spinal Issues: Conditions such as spinal stenosis, degenerative disc disease, or arthritis can also contribute to pain and discomfort.

What Can Be Done?
1. Follow-Up Care: It is crucial to maintain regular follow-up appointments with her orthopedic or pain management specialist. They can assess the situation through imaging studies and physical examinations to determine the best course of action.

2. Pain Management Options: While pain medications are a common approach, there are additional strategies that may help alleviate your grandmother's discomfort:
- Physical Therapy: A tailored physical therapy program can help strengthen the muscles supporting the spine, improve mobility, and reduce pain.

- Heat and Cold Therapy: Applying heat can help relax muscles and improve blood flow, while cold therapy can reduce inflammation and numb sharp pain. Both methods can be beneficial.

- TENS Therapy: Transcutaneous electrical nerve stimulation (TENS) can provide pain relief for some patients by disrupting pain signals sent to the brain.

- Alternative Therapies: Some patients find relief through acupuncture or chiropractic care, although these should be approached cautiously and discussed with her healthcare provider.

3. Lifestyle Modifications: Encourage your grandmother to engage in gentle activities that promote mobility without overexertion. Activities such as walking or swimming can be beneficial. Additionally, ensuring she has a nutritious diet rich in calcium and vitamin D can support bone health.

4. Consideration of Further Interventions: If pain persists and significantly impacts her quality of life, further interventions may be necessary. This could include additional imaging to assess for new fractures or other spinal issues, or even surgical options if conservative measures fail.

Conclusion
In summary, while vertebroplasty can be effective for many patients, it is not a one-size-fits-all solution. The persistence of pain in your grandmother's case may require a multifaceted approach to management, including medication, physical therapy, and possibly further evaluation for additional underlying issues. Open communication with her healthcare team is essential to navigate her treatment options effectively and improve her quality of life.

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