Studying treatments for back injuries

August 5, 2009 3:25:13 PM PDT
There is an increasingly popular operation for a broken spinal bone called vertebroplasty, where cement is injected through the skin into the bone to reinforce it. But two articles in the New England Journal of Medicine ask if the surgery has any effect at all. Sixty-nine-year-old Jean McGlone walks without pain these days, but in April, she fell off of a ladder and broke a spinal bone, a vertebral body.

"Oh my God, it was awful," she said. "It was horrible. I was on the floor and I couldn't get up."

McGlone is one of three quarters of a million people who have a spinal fracture each year.

Each of the two studies compared a group whose spine fractures got bone cement to a group that had fake surgery, in which the needle had been placed through the skin, but no cement was injected. Both studies found no real difference in pain and disability between the groups after weeks and months of observation.

"It is interesting to see that a scientific study shows what we know intuitively doesn't work for every patient," Lenox Hill Hospital's Dr. Fabien Bitan said. "And that there are alternative ways of treating patients."

Jean tried a back brace, which worked at first. But by July, she wasn't better and had the operation.

One of the major complications of injecting cement has to do with leakage out of the spinal cord near the spinal bones. The cement gives off heat as it hardens, which can cause nerve damage.

Dr. Bitan feels that surgery must be decided case by case. An editorial in the journal agrees, saying that if surgery has no clear evidence of success, doctors and patients must review the options carefully.

"Those studies are very useful to remind us that not all patients qualify and should be operated," he said. "But that doesn't replace the common sense of the doctor listening to the family and the patient and making a sound decision."

The patients who need this operation, says Dr. Bitan, are elderly, with worsening back pain who are becoming increasingly bedridden despite other treatments. The cement injection procedures are done under anesthesia and require a overnight stay in the hospital.

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WEB PRODUCED BY: Bill King


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