Ortho Dx: Severe Lower Back Pain in an Elderly Woman

Slideshow

  • Anteroposterior view

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    Anteroposterior view

  • Lateral view

    CA_OrthoDx_071118_Image-2

    Lateral view

A 75-year-old woman complains of lower back pain after falling out of bed the previous morning. AP and lateral radiographs taken in the emergency department (figures 1 and 2) show an L3 compression fracture. She is in severe pain and having trouble getting out of bed.

This case has been brought to you in partnership with the Journal of Orthopedics for Physician Assistants.

The patient sustained an osteoporotic vertebral compression fracture. Most patients who sustain this type of fracture are able to mobilize with a lumbar corset brace immediately. However, some patients have disabling pain that keeps them bedridden, which should be avoided...

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The patient sustained an osteoporotic vertebral compression fracture. Most patients who sustain this type of fracture are able to mobilize with a lumbar corset brace immediately. However, some patients have disabling pain that keeps them bedridden, which should be avoided as bed rest is associated with a high complication rate. Therefore, managing pain early is critical after a vertebral compression fracture, especially in the elderly population.

Kypohoplasty can offer immediate pain relief and improved sagittal alignment for patients suffering from an acute vertebral compression fracture. Kyphoplasty has been shown to get patients out of bed faster and improve ambulation over conservative treatment. The procedure has a 95% improvement rate and involves a percutaneous insertion of a balloon into the vertebral body to restore vertebral height. Once the superior endplate has been lifted, the balloon is removed and methylmethacrylate cement is injected into the void space to restore the height. Vertebral height restoration is better achieved if Kyphoplasty is performed within 2 weeks of fracture. One pitfall of Kyphoplasty is a small increase in adjacent level fracture after the procedure compared to conservative treatment methods of vertebral fractures. MRI is recommended prior the kypholplasty to confirm fracture acuity, rule out pathological fracture, and to confirm the posterior vertebral wall is intact. Disruption of the posterior wall (burst fracture) is contraindicated with kyphoplasty as cement could flow into the spinal canal.1,2

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).

References

  1. Park, Hyung Taek; Lee, Chang Bum; Ha, Jeong Han; Choi, Sun Jin; Kim, Myoung Soo; Ha, Jung Min. Results of kyphoplasty according to the operative timing. Current Orthopaedic Practice: September-October 2010 – Volume 21 – Issue 5 – p 489-493
  2. Rao R, And M, Singrakhia D. Current Concepts Review Painful Osteoporotic Vertebral Fracture. JBJS 2015. 85-A (10). 2010-2021
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