Chronic Back Pain – Don’t Grin And Bear It

By John Mak, MD, Board Certified Pain Management Specialist

Did you know that 80% of the 10 million Americans who are diagnosed with osteoporosis are women?  Women are thought to be more susceptible to the disease, as postmenopausal hormonal changes accelerate the bone reabsorption process.

Bone health is an ongoing concern in the medical community as the US population continues to age- more specifically, the diagnosis of osteoporosis. Osteoporosis literally means “porous bones”. Bone is a living tissue that goes through constant absorption and rebuilding.  As we all get older, the bone rebuilding processes does not keep up with re-absorption, resulting in porous and fragile bone, which is prone to fractures.

There are many factors to help prevent osteoporosis, including taking Vitamin D and Calcium supplements, exercising, and taking prescription medications to help build more bone. Despite all the above mentioned measures to treat osteoporosis, spinal compression fracture is the most common fracture in patients with osteoporosis.

Vertebral compression fracture is defined as the collapse of the vertebral body in the spine. There are 750,000 vertebral compression fractures diagnosed yearly. Compression can occur anywhere in the spine, but most commonly occurs in the upper back (thoracic spine).

When patients come to my office with symptoms of back pain in relation to any movement of the spine, the diagnosis of vertebral compression fracture is at the top of my list – especially when the back pain is made worse with walking or standing, and alleviated with rest. More serious and unstable compression fractures may have additional symptoms of leg weakness or numbness.

With imaging studies including X-Ray, CT and MRI scans, I can definitively diagnose vertebral compression fractures. On the imaging scan, I will be able to see a decrease in height and possible instability in the spine vertebral body.

Once the diagnosis of a vertebral compression fracture is confirmed, I will start with a conservative treatment plan consisting of short term bed rest, pain medication, bracing, and a possible trial with an epidural steroid injection. Bed rest and bracing aims to limit movement at the fracture site, as one would cast a leg fracture. Medications and an epidural steroid injection will help decrease inflammation and swelling at the fracture site. The combination of these conservative treatments can usually control the pain adequately and allow the patient to recover.

But there are certain patients that continue to suffer from back pain due to spinal instability from the compression fracture. Being trained in the latest advances in interventional pain management allows me to offer patients 2 non-surgical methods to treat compression fractures.

The first non-surgical method is a Vertebroplasty procedure. It is performed under mild sedation in an outpatient setting to stabilize the collapsed vertebral body. Under x-ray guidance, a needle is guided into the collapsed vertebral body and bone cement is injected to stabilize the fracture.

The second non-surgical method is Kyphoplasty, which is a slight modification of the vertebroplasty procedure. There is an added step where a balloon is inflated in the vertebral body to help create room to inject the bone cement and to augment the height of the collapsed vertebral body. Vertebroplasty and Kyphoplasty are some of the most gratifying procedures I perform, as patients often get pain relief within hours after the procedure!

Patients are discharged home the same day with two Band-Aids over the puncture site. Numerous studies indicate that 90% of patients undergoing vertebroplasty get relief within 24 hours. This allows patients to quickly regain their independence and return to their normal level of activity.

Unfortunately, many people feel pain due to a vertebral compression fracture is something they have to live with, or is an unavoidable part of growing older. The physicians at Premier Pain Centers are all board certified and versed in the latest advances in the treatment of chronic and acute pain.  If you suffer from low back pain or a vertebral compression fracture, contact Premier Pain Centers at (732) 380-0200 for a consultation.