Cement for bones shores up spines

Doctors fix fractured vertebrae with a new procedure that helps osteoporosis sufferers.

By WES ALLISON

© St. Petersburg Times, published June 25, 2000

SAFETY HARBOR -- Even as the doctor probed her spine with long metal needles, searching for the right path into the collapsed vertebra that has caused her so much pain, Helen Wecera never lost sight of her goal.

"Does this mean I'll be able to go dancing again?" Ms. Wecera, 84, asked, her voice muffled a bit by the pillow.

"That's what we're hoping," Dr. Gerald A. Niedzwiecki, an interventional radiologist, told her.

In a radiology suite at Mease Countryside Hospital, the doctor filled several syringes with a pasty cement, then stuck them into the middle of her back and pushed the plungers. The cement oozed into Ms. Wecera's T-9 vertebra, which had fractured about six months earlier and stubbornly refused to heal.

Ms. Wecera is one of a growing number of senior citizens, mostly women, who are turning to a new procedure called vertebroplasty to shore up fractured vertebrae caused by osteoporosis. It would be a day or so before she knew how well the procedure worked, but the doctor predicted good results.

"The pain, for most patients, is gone the next day," said Niedzwiecki, whose patients call him Dr. Jerry. "They really regain function very quickly, and really get their legs back."

Ten-million Americans, 80 percent of them women, have osteoporosis, and 18-million have low bone density that puts them at great risk of developing it. Low bone density makes you prone to breaks, and 700,000 people -- again, most of them women -- suffer painful vertebral fractures each year, according to the National Osteoporosis Foundation.

First, the weakened vertebra compresses under the body's weight; under X-ray, it looks like a partly crushed soda can. Then, Niedzwiecki explained, "You get to a point where eventually it goes "crack,' and that's it."

Until now, there has been no real cure. Doctors could prescribe rest and painkillers, but the fragile bone wouldn't always heal on its own. Many patients suffered from chronic pain that kept them from performing basic tasks and, often, robbed them of their independence.

Ms. Wecera, a former Marine who lives in New Port Richey and likes to keep on the move, is typical: She fractured two vertebrae several years ago in a fall, and they healed fairly well. But the most recent fracture has been giving her the devil for about six months, with no signs of getting better, and it dragged down her quality of life.

"I have to rest a lot, even doing the dishes," Ms. Wecera said as she was prepped for the operation. "I do a little bit, then rest. Even shopping -- I can only shop for about 10 minutes at a point, then I have to rest again."

The procedure costs about $1,000. Medicare began covering it in March, and several Tampa Bay area hospitals now offer it, but radiologists say many people and their doctors don't seem to know about it. Niedzwiecki said most of his patients are referred by friends, or they learn about it during their own research into their back pain. And not everyone qualifies.

He has done about 40 procedures for Morton Plant Mease hospitals in Pinellas County in the past 14 months, while a radiologist at Tampa General Hospital who helped pioneer the technique in America, Dr. Avery Evans, has done about 400 in the past four years. St. Joseph's Hospital in Tampa has done about 70.

The French have used vertebroplasty since about 1984. A doctor from the University of Virginia, Jacques Dion, brought it to the United States five years ago and began training physicians.

Evans, who practiced under Dion at the University of Virginia, has since trained dozens of other doctors in the procedure, and sometimes he does as many as three vertebroplasties a day.

"I tell patients it's good, but it's not magic," Evans said recently. "It works for most people, but it doesn't work for everybody.

"The longer the patient has had the fracture, the less likely they are to respond. But I'll still do them, and a significant number of patients will still get some pain relief."

The procedure also can be used for other types of fractures of the vertebrae, besides those caused by osteoporosis.

One of Evans' patients, Edna Peck of Lakeland, had vertebroplasty on an ornery vertebra on a recent Tuesday at TGH, and by Thursday she was planning to go out to dinner. She had two other vertebrae treated in March at Shands at the University of Florida, Gainesville, but Tuesday's procedure worked much better, she said.

"I just feel like it is a miracle," Mrs. Peck, 78, said. "I have been in so much pain. I've been taking six to eight Darvocets a day.

"And I'm not the type of person that likes to stay doped up. But I was in so much pain that it hurt me to move."

The concept of vertebroplasty is fairly simple: A cement the consistency of pancake batter, which has been used since the 1970s in joint replacements, is slowly injected into the fractured vertebra. Because the bone is porous, the cement fills the air pockets inside, just as water fills a sponge.

The cement is treated with barium so the radiologist can watch it on an X-ray monitor as it fills the vertebra. It hardens in about 15 minutes, securing the fracture and protecting the bone from compressing further. It's like setting the bone from the inside.

Most patients get only a local anesthesia and a mild sedative and can go home the same day. The whole procedure typically takes about an hour, although there can be complications. The mineral density of Ms. Wecera's spine was so thinned by osteoporosis, for example, that her vertebrae didn't show clearly on the X-ray machine. The doctor had to run several CT scans to make sure he had the right spot.

Evans estimates the chance of complications or risks runs about 5 percent, but he and Niedzwiecki stressed that any surgery near the spinal column can be dangerous. If it's not done correctly, the cement can push into the spinal canal and cause nerve damage or even paralysis. In Maryland, two patients died after a doctor injected too much cement and it traveled through the veins to the lungs.

Because it seems like a simple procedure, Evans said, some doctors may try it without appropriate training. Florida regulators are trying to crack down on doctors who practice outside their scope of training, and patients should not be shy about asking for references or details of training and experience.

The National Osteoporosis Foundation still is studying the procedure and makes no recommendations about it, spokeswoman Mary Natchipolsky said. "It certainly has promise. . . . We're always very pleased to see new research going on for potential treatments."

As for Helen Wecera, a week after her surgery she said her back was much improved. She figured she would be back to her old self soon.

"It's better," she said Friday evening. "It's just an ache now and then, instead of a pain. It'll be a little bit, and then I hope everything will be fine."

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