“One day, when I was getting out of bed, my upper back and chest felt incredibly painful. I struggled to walk because of the pain and it got steadily worse,” Lynn Hart, a 53-year-old former nurse and teaching assistant from Normandy, Middlesbrough —a town in England, revealed. Hart, as well as her mother, aunt, and brother all, live with osteoporosis.
Osteoporosis is a medical condition where the bones become brittle and fragile from loss of tissue, typically as a result of genetics, hormonal changes, or a calcium/vitamin D deficiency.
But the Hart family is not alone in their diagnosis. 1.5 billion people worldwide suffer from chronic pain and unfortunately, out of those numbers, only 23 percent found opioids to be an effective measure for pain relief. What's the patient to do when nothing seems to work?
“My doctor sent me for an X-ray, which showed I’d fractured one of the 24 vertebrae in my spine, above my shoulder blades, and I was prescribed painkillers,” this Backer announced. “I’m not sure what caused it, but I had fallen in the kitchen weeks earlier.”
When painkillers aren't killing the pain, surgery may be required. Let's dive in and find out how inserting a balloon filled with cement works to heal broken bones of the spine.
For the patient who has spinal osteoporosis, maybe you were told your spinal fractures were in a surgically uncorrectable area. As you cough and move about, a simple sneeze breaks yet another rib. This at least is true for Hart.
"I’d been diagnosed with osteopenia (a low bone density disorder), a precursor to osteoporosis when I was 38 and my rheumatologist started monitoring my bone density every two years with a DEXA scan," Hart shared.
She adopted a calcium-rich diet and began weight-bearing exercises to retain bone strength. But every scan showed more and more bone loss accelerating her diagnosis and even more pain. Until it couldn't get worse.
"An X-ray found I’d fractured another three vertebrae lower down my back and that they’d then healed naturally in a wedge shape, which is why I’d lost height and was stooping — the excruciating pain being caused by trapped nerves," she said.
At that point, it hurt to walk or do anything. Hart remembers, "My husband, Christopher, had to take a week off work to look after me. Although I had painkillers and muscle relaxants to ease my spasms, I had to grip furniture to walk, and simple tasks such as filling kettles or opening doors were agony."
If you get to the point where you're missing work like Hart did or every move you make, fractures another vertebra, your doctor may need to take a more aggressive approach.
"My rheumatologist swapped me to a yearly intravenous infusion of zoledronic acid (a medication used to treat high blood calcium levels [hypercalcemia] that may occur with cancer) to build up my bone density, hoping to prevent further fractures," Hart mentioned.
As more days go by, the knock on Hart's confidence began to take a tool.
"I was scared to go out as I dreaded the thought of falling — I’d freeze in crowded places in case someone knocked me."
She couldn't do household chores, drive, visit her children or socialize. It was then that an MRI scan displayed a vertebra collapse — causing a lump to appear in the middle of her back that was the reason for her increased pain.
Her rheumatologist then suggested surgery with a spinal specialist, Dr. Dan Fagan at the BMI Woodlands Hospital in Darlington, England. "Mr. Fagan reassured me the risks were small — and I was desperate to stop the pain."
Luckily for all of us, a balloon kyphoplasty is considered the best alternative for anyone living with osteoporotic spinal fractures that don’t heal correctly. Like Hart, it's possible to generate a permanent crouch and lump, a dependence on large amounts of narcotic medications or live in so much pain, it hurts to simply get out of bed — a sign that the fracture won’t heal without surgery.
One possibility is a 'vertebroplasty', where bone cement is inserted intravenously under high pressure into each fractured vertebra.
With this option, quality of life should significantly improve with a 15 to 20 percent chance of cement leakage. Worst case, the leakage causes severe irritation and aggravates the nerves. In extremely rare cases, paralysis of the lower body can take place.
The superior option with equal success rates is the balloon kyphoplasty that Hart received. It's superior because it has a lower — 3 percent — risk of leakage and the cement is injected at a lower pressure giving the surgeon more control.
A balloon kyphoplasty for one fractured vertebra normally takes around 30 minutes with a general anesthetic.
Fagan discloses some details about the operation:
"I make two tiny horizontal incisions on either side of the spine. I then insert hollow needles into the vertebra."
Then, he threads a deflated balloon (10mm to 15mm long). The end of the balloon is connected to an expansion machine that packs it with water. The force drives the spongy piece of the bone outwards, sealing off the fracture.
"I then remove the balloon and using a tiny cylindrical metal tube, insert the cement,” Fagan added. “I watch this on [an] X-ray to ensure the cement fills the space and doesn’t leak. I then stitch the incisions."
The National Institute for Health and Care Excellence (NICE), now says that balloon kyphoplasties should be offered to all patients in chronic pain from osteoporotic spinal fractures.
After having this procedure, you can expect an increase in height, on average 5mm per fracture, particularly if there are multiple breaks. The procedure operates greatest within three months of the initial fracture due to the fact that the bone is more responsive to the balloon’s force earlier on.
Unfortunately, in 3 percent of cases with multiple fractures, a second operation may be required. In Hart's case, it was.
"The next month I sustained another fracture after kneeling on the floor. The vertebra under the one that had been treated was also collapsing. Dr. Fagan did another balloon kyphoplasty and I felt an instant benefit," she said.
Six weeks later, her pain was gone. She could do housework, drive and even go out.
"It took a fortnight to recover but I noticed a real difference. I could walk further, stand for longer, the pain was vastly reduced and I enjoyed a weekend away in Cambridge," she said.
There is hope.
Caption: A hopeful Hart posses after her second operation.
"I love seeing people jump out of bed after the procedure because the cement sets so quickly," Fagan affirms. "They can stand upright when they were hunched over before. Some dance around, delighted that the pain is gone."
Hart certainly did and continues to.
"My walking stick’s been put away and I’m no longer stooping," she concludes. "I still have a bad back, but I’m no longer an invalid."
Here's to validation everywhere.