Many of those we talked to have had fractures before and after their diagnosis of osteoporosis and several have had surgery to help decrease the pain associated with spinal compression fractures; to mend a broken femur, or repair a wrist that could not be mended with a cast alone. Here people talk about their experiences.
Percutaneous Vertebroplasty and Balloon Kyphoplasty
Percutaneous Vertebroplasty and Balloon Kyphoplasty are procedures used to help decrease pain associated with spinal compression fractures. However, surgery is not suitable for the majority of people with spinal fractures. They are considered for people whose spine fractures haven’t healed properly and who continue to have severe pain.
Percutaneous Vertebroplasty and Balloon Kyphoplasty do not improve bone strength or reduce fracture risk so should given along side drug treatment. These procedures are approved by NICE (National Institute for Health and Care Excellence) and are available in some specialist hospitals in the UK.
These procedures are minimally invasive treatments a very small cut is made in the skin at the site and a hollow needle is inserted through the skin into the collapsed vertebrae. During surgery, image-guided x-ray assists doctors when directing the needle through the skin into the spinal bone and then a special orthopaedic cement mixture is injected into the fractured vertebra. In balloon kyphoplasty, a balloon is first inserted through the tube and into the fractured vertebra where it is inflated to push the bone back to its normal height and shape. The balloon is then removed and the cement is inserted into the cavity created by the balloon. Both procedures usually take place as day surgery. These procedures are more likely to be effective in the early months after fracture but most compression fractures heal without intervention within 6-8 weeks with improvement in pain, so Percutaneous Vertebroplasty and Balloon Kyphoplasty are not generally considered as a treatment option until after this time.
With both procedures, there is the risk of the cement-like paste ‘leaking’ or moving out of place and a possible increase in risk of fracture to vertebrae above or below the site of the procedure. As with all surgery, there are other risks including infection, nerve damage and paralysis and reactions to anesthetics.
Noreen and James talked to us about their experiences of having balloon kyphoplasty and percutaneous vertebroplasty. Both experienced severe pain following their spinal fractures. The severity of it made any daily activities such as getting in and out of bed, bending and getting up from a chair very difficult. So after having an MRI scan and an assessment with a specialist consultant, both were happy to have surgery to get rid of the pain. Noreen remembers that during her first consultation she was ‘pleased’ to hear the osteoporosis nurse describing her pain to her. But James – who waited for almost a year to have his MRI scan – wondered why he was referred as a non-urgent case by his GP (vertebral fractures can easily be picked up on an ordinary x-ray of the spine).
James and Noreen had their procedures done in different hospitals and in different parts of the UK but both said that specialists doctors and nurses discussed with them all the information they needed to know about the procedure and the possible risks involved. Noreen pointed out that after her MRI scan things preceded fast and there was no time for her to worry. Percutaneous vertebroplasty and balloon kyphoplasty are usually successful at alleviating the pain caused by a vertebral compression fracture, but only where usual treatments to control pain have failed, but in the cases of Noreen and James the damage caused by osteoporosis had been done before diagnosis and before treatment. Besides, both had to wait for a few months to have surgery. These procedures are only suitable for a small number of patients as, in the majority of patients with vertebral fractures, the pain settles after about eight weeks.
After his percutaneous vertebroplasty James said that he felt more comfortable, there was no serious pain and was able to walk more easily but his improvement was short-lived because a third vertebra collapsed. Another percutaneous vertebroplasty was performed but it had to be stopped because the cement-like paste began to leak. He is due to have it done again soon. Despite this set back James recommends percutaneous vertebroplasty to others because he was able to appreciate its benefits after his first two collapsed vertebras were repaired. This illustrate that these two procedures should be complemented by drug treatment for osteoporosis as they do not reduce risk of fractures at other sites.
Two of the people we talked with were offered these procedures but did not want to have surgery. Sheila declined her consultant’s suggestion of having balloon kyphoplasty and Ann who has lost height, would not consider having percutaneous vertebroplasty. As a nurse Ann knows that it is the only procedure that may help restore height to her vertebras, hence reducing the curvature of her spine. Both have concerns about the risk of the paste leaking and migrating to other organs, especially the lungs which would be fatal.
Other surgical procedures
Surgery may be required to repair some osteoporotic fractures. Most peripheral fractures (e.g. wrist fractures) can be healed with the use of cast alone. But some may require surgery. Hip fractures almost invariably need surgery. These procedures are very successful at repairing fractures, reducing pain and increasing mobility or function.
Anyone over the age of fifty who sustains a low trauma fracture should be investigated for osteoporosis when attending a fracture clinic. The experiences of those we talked to differ and some were referred for a DXA scan and in other cases there was no further investigation (see also Being diagnosed with osteoporosis
People who had a wrist fracture were usually put in a cast and recovered within a couple of months. Joan had had several falls that have resulted in Colle’s fractures and on one occasion she fractured both wrists at the same time. And Joan has needed wrist and arm surgery to correct fractures that could not be corrected by casts alone.
Elderly people are particularly susceptible to hip fractures. The elderly tend to lean slightly backwards or sideways when they walk hence they are more likely to fall on the hip and fracture it. A hip fracture occurs at the top part of the femur. For a hip fracture the surgical procedure is done either to stabilise the hip joint with metal plates and pins or to replace the hip completely. Sydney who is age eighty-six sustained a hip fracture three years ago when getting off his bike for no apparent reason. The surgical procedure he had done was to stabilise the hip joint. Elderly and frail patients are more at risk of developing complications and their stay in hospital after hip surgery can be for two or three weeks. Sydney said that he had no infection or any other complications.
The hospital experience
People who have recently spent time in hospital because of surgery or recovering from disabling fractures praised NHS hospitals. In particular people talked about the support, expertise and care they received, the extra nursing staff, new ward arrangements and help given during mealtimes. Christine commented on the kindness shown to her by the nurses while she spent two months in a community hospital recovering from a fracture. Beryl. has been in hospital a few times and said about nurses ‘I can’t fault them. I don’t think, they’re, given enough praise, you know, most nurses’. And James describes the consultant who has done his percutaneous vertebroplasty procedures ‘first rate and very thorough’ (see also Communicating with health professionals
However, Sydney thinks that he was discharged too soon after having surgery for a broken hip. He felt that he was still not fit enough to cope on his own at home.