Miracle cure for spinal fractures

A new procedure which involves injecting cement into the vertebrae to strengthen bone that has collapsed due to tumours, accidents or osteoporosis, has already transformed some patients' lives


A treatment that enables the bed-bound to walk again sounds too good to be true. But this spectacular outcome, known to doctors as the "Lazarus effect'', can be achieved by vertebroplasty, a new procedure for spinal fractures that involves injecting cement into vertebrae. Some patients' lives have already been transformed by the technique, which stabilises and strengthens bone that has collapsed due to tumours, accidents and – most commonly – osteoporosis.

Each year, doctors in Britain see about 120,000 people with spinal fractures caused by osteoporosis: approximately one woman in six will suffer an osteoporotic vertebral break at some time in her life. Most of these heal naturally within a few months, but some leave patients in continuing pain and with restricted mobility.

Options limited

"For these people, treatment options are fairly limited,'' says Dr Peter Selby, a consultant physician at Manchester Royal Infirmary in the UK. "Patients may be advised to rest in bed, take painkillers or try acupuncture or a TENS machine. Some are just about able to live a normal life with a lot of pain relief. Others are hardly able to get out of bed. As a doctor, you do not often see people who are ill one moment and better the next, but that can happen with vertebroplasty.''

One man, whose bones had been thinned and vertebrae crushed by years of steroid use, had been wheelchair-bound for six months when he visited Dr David Wilson, the radiologist who brought vertebroplasty to Britain from France. "He couldn't work and he couldn't get out to watch his hobby, which was hill-climbing, let alone do it himself,'' says Dr Wilson, who is based at the Nuffield Orthopaedic Centre NHS Trust in Oxford. "He was back working and hill-climbing immediately. For him, it was a miracle cure.''

Partly because of the risks involved, vertebroplasty tends to be a treatment of last resort here, though it is widely used in America.

First, doctors confirm that the pain is actually emanating from the fracture. Once the patient is sedated, a radiologist injects minute amounts of cement. No more than three vertebrae can be treated at one time.

No controlled trials

"There have been no controlled trials of vertebroplasty but observational studies show that about 80 per cent of patients experience partial or total relief of their pain, between 10 and 20 per cent are completely cured and around 20 per cent are not helped at all,'' says Dr Wilson. The procedure is currently under review by the National Institute for Clinical Excellence.

Complications are rare but not unknown. Occasionally, the cement can leak and travel into the wrong areas, leading to damaged veins, nerves and spinal cord. "If you are giving the injections under close X-ray control, these things should not happen,'' says Dr Selby.

Ann Davey, a secretary from Prestwich in Manchester, has had four vertebrae filled in three separate procedures. She still has pain and restricted mobility, but "shudders to think'' how she would be without vertebroplasty. "I think I would be like a concertina: I would have collapsed,'' says Davey, 58, who has severe osteoporosis. "This has given me rigidity. It has also reduced the pain.'' A new technique, kyphoplasty, is undergoing a trial in Britain. A balloon is inserted through the needle and inflated so that it decompresses the fractured vertebra. The space is then filled with cement. Theoretically, this could lessen the risk of the cement leaking out of the vertebra. Nobody knows exactly what the long-term consequences are of having cement in your spine. The technique was first used in France 15 years ago but there has been no published follow-up of these patients.

Fellowship awarded

Dr Ruth Wilcox, a research fellow in the School of Mechanical Engineering at Leeds University, has been awarded a five-year, £150,000 fellowship to create a cement that injects, bonds and works well in the human body. She is investigating the effect of different injection techniques and cement mixes on the spine with the aim of identifying the best possible method and materials.

At present, vertebroplasty is used only on fractures, because it is hard to tell which vertebrae are likely to collapse. "It is conceivable that in time, with improved imaging techniques, doctors will be able to locate which vertebrae are at risk and augment those with cement before they break,'' says Dr Wilcox.

© The Telegraph Group Limited, London 2003