Binding the Bones of Osteoporosis

eventy-eight-year-old Bernice Childs of Tampa, Fla., was back at Johns Hopkins recently to have another of her vertebrae restored through a process called percutaneous vertebroplasty. This one she fractured when she had the flu and couldn’t stop sneezing. Childs, who has osteoporosis, is amazed by the unusual procedure in which the bone cement methyl methacrylate is injected into the spine to shore up tiny breaks. During her first visit to Hopkins, she’d arrived in agony in a wheelchair for a repair of three splintered thoracic vertebrae and left a couple of days later pain-free and in a walker.

Kieran Murphy, M.D., the interventional neuroradiologist who executes the approach, agrees it’s amazingly effective in reinforcing bone and eliminating back pain, particularly in the 25 percent of women over the age of 50 who suffer one or more vertebral compression fractures due to osteoporotic bone loss. “With this technique,” he says, “we can get them out of bed quicker, relieve their pain and restore their quality of life. We also help stave off that slippery slope into institutionalization.” Murphy adds, however, that vertebroplasty has also proven a remarkable remedy for younger patients with metastatic disease or traumatic injuries to the spine.

The outpatient procedure takes about an hour. With the patient under local anesthesia and IV sedation, Murphy presses a bone-marrow needle into the supporting posterior part of the vertebral body. Then, using CT scanning and fluoroscopy, he guides the needle into the center of the collapsed vertebra, slides a catheter through the needle into the porous bone and packs it with the glue. The substance hardens immediately, preventing further breakdown and painful friction of the bone. Murphy, who performs about 40 vertebroplasties each year, emphasizes that the challenge is to do no harm. “If the cement gets in the wrong place,” he explains, “the spinal cord can compress and the patient can become paraplegic.” Key to success, he says, is careful patient selection and a meticulous technique.

—-GL