PAIN MANAGEMENT
Dr. Stan Golovac
Nonsurgical Treatment Stabilizes Collapsed Vertebra
Dr. Stan Golovac
YOU DON’T HAVE to live with back pain from a compression fracture of the spine any more. In the past, painful compression fractures were often left untreated, treated suboptimally or worse, undiagnosed.
This painful condition, often caused from osteoporosis and traumatic fractures, or occasionally multiple myeloma and other types of cancer, can be very effectively managed by vertebroplasty, a nonsurgical treatment which stabilizes the collapsed vertebra with the injection of medical-grade bone cement into the spine, and allows solidification of fractures in minutes.
Vertebroplasty was first performed by Drs. Galibert and Deramond in France in 1984 to treat compression fractures caused by bone cancer, and later to treat compression fractures caused by osteoporosis.
Non-surgical vertebroplasty was introduced in the United States in 1994 and has become widely available since 1997 as a treatment for pain associated with compression fractures due to osteoporosis. Validated studies by Dr. Deramond and colleagues have shown the procedure to provide rapid and complete pain relief in more than 90 percent of osteoporotic cases. The follow-up in this patient population ranged from one month to 10 years with evidence of prolonged pain relief.
Women at Risk for Osteoporosis
It is estimated that one in three women and one in 12 men over the age of 50 worldwide have osteoporosis. Over 700,000 Americans develop compression fractures of the spine that are so painful that they may quit their jobs, stop participating in activities they enjoy, are confined to a brace, bed rest and/or chronic pain medications, none of which actually effectively address the anatomic condition or affect long term relief.
It is very important for someone with persistent spinal pain lasting more than three months to consult their physician, and people who require constant pain relief with narcotics should seek help immediately. The diagnosis for this condition is simple. If your physician’s comprehensive medical history and physical exam suggest osteoporosis with a possible compression fracture of the spine, an MRI (Magnetic Resonance Imaging) should be done to check for the fracture and determine whether it is relatively new in onset or chronic and healed. If the fracture has already healed, there is a high probability that it healed in a compressed or flattened wedge shape. Once this occurs, the compression fracture cannot be treated effectively.
Once the diagnosis of a painful compression fracture of the spine is made, serious consideration should be given to vertebroplasty. Vertebroplasty not only can reduce pain, but also prevent further collapse of the vertebra, thereby preventing the height loss and spine curvature commonly seen as a result of osteoporosis. Vertebroplasty dramatically improves back pain within hours of the procedure, provides long-term pain relief and has a low complication rate, as demonstrated in multiple studies.
When considering vertebroplasty, first and foremost, be sure to find a qualified trained specialist that is certified to perform the procedure and manage the condition and any residual symptoms that may result from the procedure.The procedure is performed as an outpatient, meaning you will not be required to stay in the hospital or even stay over night. In fact, most vertebroplasties can be done in an ambulatory facility or doctor’s office. Usually a mild sedative is given to calm anxiety and a local anesthetic is used to numb the needle entry site.
With the use of an x-ray beam (continuous, moving X-ray imaging) called a fluoroscope, the physician can visualize the fracture before the cement is placed, during the actual delivery and after completion. The physician inserts a needle about the width of a cocktail straw through a nick in the skin in the back, directing it under fluoroscopy into the fractured vertebra. The medical-grade bone cement is then injected into the vertebra. The cement hardens within 15 minutes and stabilizes the fracture, like an internal cast, which prevents further collapse and stops the pain caused by bone rubbing against bone. The procedure routinely lasts 30 to 60 minutes.
JERALD STABLER, at right, with Dr. Golovac. At 59 years old, Stabler was suffering from two very painful vertebral compression fractures related to Agent Orange exposure in Vietnam. After undergoing vertebroplasty he is able to stand, bend, twist, flex and even dance.
Immediate Pain Relief
Some patients experience immediate pain relief after vertebroplasty. Most report that their pain is gone or significantly better within 48 hours. Many people can resume their normal daily activities immediately.
Jerald Stabler at 59 years old was suffering from two very painful vertebral compression fractures due to multiple myeloma (a type of cancer of the bone) related to Agent Orange exposure in Vietnam. Because of severe spine pain, he was not able to stand, dance or even sit without severe discomfort. Having exhausted conventional treatments without relief and being given no hope to improve, he was referred for consideration of vertebroplasty. After undergoing vertebroplasty at multiple levels, he now is able to stand, bend, twist flex and even dance with his lovely bride. Vertebroplasty helped Jerald restore a semblance of normalcy to his life and get through each day with his pain controlled.
Remember, although conventional conservative treatments such as bracing, calcium, pain medications, and rehabilitation to restore function of the spine can be a very early consideration in the management of compression fracture, early evaluation by a qualified, skilled physician and consideration of vertebroplasty may be the best path to effective pain management and return to a more complete and gratifying quality of life.
Stanley Golovac, MD is the co-director of Space Coast Pain Institutue. Dr. Golovac completed his education at UTESA University in 1985, where he received his Doctor of Medicine. Upon graduation, Dr. Golovac completed his postgraduate training in Family Practice Residency Program at St. Mary Hospital in New Jersey and in the Department of Anesthesiology at Jackson Memorial Hospital in Miami. Dr. Golovac gained extensive clinical experience in anesthesiology, emergency room medicine, and alternative services. He served as Assistant Clinical Professor of Anesthesia at the University of Miami Jackson Memorial Center for several years, and then as a practicing Pain Consultant in the Miami area. He currently utilizes his expertise at Cape Canaveral Hospital/Health First Pain Management and the Space Coast Surgery Center of Pain Management. For more information log on to YourPainInstitute.com
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