FAQ Category: Thoracic Spine

Osteoporosis leaves bones weak and at risk for unexpected fractures. The spine is a common site for these compression fractures. Just the weight of the bones and gravity are enough to cause the bone to burst or collapse on itself.

The treatment you read about uses a special instrument to slip into the main part of the bone without making a cut or incision. With vertebroplasty cement is injected right into the center of the bone. Kyphoplasty is slightly different.

First a special balloon is inserted into the bone. Then it’s inflated to form a cavity and lift the bone off itself. Then the cavity is filled with a special cement called
PMMA. The doctor decides which way to do the operation based on the type of fracture and the condition of the bone.

I had a lumbar laminectomy for back and leg pain. A week after the operation my symptoms were much worse with the added problem of bladder problems. After more testing, it looks like the problem is really higher up in the thoracic spine. I’ve been told the first
operation was necessary to show the problem more clearly. Is this just some specialist covering for a mistake?

Mistakes do happen in the medical world. It’s complex and our ability to find things is somewhat limited despite modern day technology.

In the case of the spine, what you’ve been told may very well be true. Researchers have put this theory out, but they can’t prove it yet. They say a laminectomy can alter the pressure and flow of the cerebrospinal fluid. This liquid cushions and protects the
spinal cord and the brain.

Symptoms can be masked or hidden for a long time. It’s not until a change occurs somewhere else along the spine that the patient’s symptoms increase enough to identify them. A recent report from Japan points out that a careful exam along with imaging studies is needed when the patient’s symptoms don’t match the testing results. This may
be the only way to find this type of problem early before permanent damage occurs.

A meningioma is a tumor that is usually benign and slow-growing. It occurs in the layers of the meninges. The meninges are the lining or membrane enclosing the
spinal cord and brain.

You didn’t say where your daughter’s meningioma is located. Although these tumors are benign, they can put pressure on nearby tissues. That’s why they are usually removed. They are more common in women and rarely occur in children.

Paralysis can be temporary in cases like this, especially if she wasn’t completely paralyzed before the second operation. Timing is important, too. The sooner the pressure is taken off the spinal cord, the better its chances of recovery. Irreparable damage can
occur if months to years pass by before the problem is diagnosed.

She may get partial recovery with some losses in sensation, strength, or bowel and bladder control. No one will know the final outcome for many months to come. Encourage your mother-in-law to take a “wait and see” approach and not assume the results are final right after this operation.

Most patients with back pain of unknown cause are given muscle relaxants, anti-inflammatories, or painkillers. Drugs for pain range from over-the-counter analgesics to
prescription narcotics.

Studies show muscle relaxants and narcotic analgesics aren’t likely to help. More and more doctors are giving patients newer types of anti-inflammatories. However, the ability of these medicines to reduce pain is under question. It may be that doctors’ practices are influenced more by marketing from drug companies than by results.

Until more is known, patients are often told to take a nonnarcotic analgesic for pain while remaining as active as possible. Check with your local pharmacist for the best over-the-counter product to take. If you continue to have pain that comes more and more often and lasts longer and longer, see your doctor.

Doctors don’t agree on the use of braces after vertebral compression fractures. There aren’t enough studies to clear up this debate. Some studies show activity is just as helpful as bracing after this type of fracture.

Some doctors use the patient’s symptoms as a guideline. If the patient can sit comfortably and without pain and has reasonable control over his or her upper body, then bracing may not be needed.

A recent study suggests taking an X-ray sitting or standing. This will show any worsening of the fracture with weight-bearing. Most X-rays are taken lying down. If there is further collapse of the bone in the upright position, surgery may be needed.

An unstable fracture can be the problem. Pressure through the spine can cause a damaged or fractured bone to collapse even more. Sometimes a standard X-ray will show the need for surgery to stabilize the spine after fracture. Doctors look for loss of vertebral
body height and the amount of forward curve of the spine. This type of spinal curve is called kyphosis.

In other cases a second X-ray in the sitting or standing position is needed. It isn’t until the patient puts weight or force through the spine that the damage is seen. Vertebral collapse of more than 50 percent with a greater than 20-degree kyphosis are usually signs that surgery may be needed.

There are 12 ribs in most people. The first seven are called “true ribs.” They attach to the spine in the back and to the breast bone (sternum) in the front. There are actual joints where the first seven ribs attach to the spine.

The lower ribs attach to the back bone, but don’t connect directly to the sternum. These are called “false ribs.” The false ribs (numbers 8 – 12) don’t form true joints and the ligaments are poorly developed. Ribs 8, 9, and 10 are connected to one another in the
front below the sternum by thick cartilage.

The bones in the spine are supported (in part) by the rib cage structure. However, this support is lacking in the false ribs, especially at the very bottom of the rib cage at T11, T12, and L1. The 11th and 12th ribs are called “floating ribs.” These are very short
and don’t attach in the front by cartilage to the other ribs.

A sudden, unexpected force in weak or osteoporotic bones can cause fractures. Injury is more likely in the smaller vertebrae without the supportive structure of the rib cage (T11, T12, and L1).

The Scoliosis Research Society has given us some guidelines to use. Pain and a spinal curve that’s getting worse instead of better are the two most common indications.

Curves that measure more than 65 degrees are considered for surgical correction. This is a measurement of the upper back’s forward curve. The normal curve is between 20 and 40 degrees.

There isn’t much debate about when to do surgery. The real decision is on what kind of surgery to do. Posterior fusion alone is linked with loss of correction.

Surgeons are starting to look at combining a release in the front of the spine with a fusion in the posterior vertebrae. There may be a better correction with less loss this way.

Scheuermann’s disease or kyphosis is a rigid deformity of the spine. Instead of a flexible spine, the back becomes stuck in a rounded or curved position. The condition usually affects the upper back but can occur in the upper lumbar area.

Bracing and exercises are often the first treatment choices. They work best when the spine is still flexible. The patient must be young enough that the bones haven’t stopped growing yet. Skeletally mature patients don’t usually respond to bracing.

Your daughter will be followed closely using X-rays to measure the curve. Surgery may be needed if bracing fails to hold the spine.

When vertebral bones are weak or brittle from osteoporosis they can collapse. This is called a vertebral compression fracture. If the bone doesn’t heal or doesn’t get enough blood supply, a space or pocket occurs. This air-filled cleft inside the vertebral body can be seen on X-ray and MRI.

Special X-rays show the cleft gives the bone motion where there shouldn’t be any movement. The best way to treat this is to inject cement into the bone to fill up the space and hold the bone together. Pain relief is immediate because the cement stops this unnatural motion.

A vertebroplasty is the injection of a special cement through a needle into a weak or fractured vertebral body. The surgeon is guided using a special X-ray called fluoroscopy. It’s a way to decrease the patient’s pain while strengthening the bone.

his treatment is used for bone collapse from osteoporosis at all levels of the spine from the neck down.

yphoplasty uses the same idea but instead of cement, an inflatable balloon is used to expand a collapsed vertebral body. The balloon is blown up to restore the vertebral body as close as possible to its natural height. Then cement is injected into the cavity.

Making an opening with the balloon allows cement to go into the cavity under lower pressure than during vertebroplasty. There’s a risk of re-fracture when the pressure is
more than the bone can handle. One problem with kyphoplasty is that the cement can leak outside the vertebral body.

That is a good question. The answer isn’t really one or the other. It’s probably both. Studies show a higher rate of vertebral fractures in the year following a vertebroplasty compared to patients with the same problem who don’t have the vertebroplasty.

It looks like increasing age, rate of falling, and other health issues add to the risk of re-fracture. Early studies reported as high as 52 percent chance of refracture after a vertebroplasty. Those numbers seem to be declining quickly as doctors gain experience with this treatment option.

Your father’s surgeon will have to counsel you on this. X-rays and MRIs will show the condition of the bone and the amount of damage present. The condition and position of the
implant will be checked too.

The implant may have to be removed. The bones are then fused together. There are some
treatments for vertebral fractures such as vertebroplasty and kyphoplasty.
In the first procedure, cement is injected into the bone to seal the fracture. The cement fills the spaces and strengthens the bone so it is less likely to fracture again.

yphoplasty is used when the bone has fractured and collapsed. A needle is inserted into the bone and air is used to lift and realign the bone fragments. Then cement is injected into the air space to hold the bone up.

The use of artificial disc replacement is very new. Kyphoplasty or vertebroplasty on a spine with an implant is also a new situation. Fortunately vertebral fracture during or
right after disc implantation is rare.

Plasty is a term that means plastic or restorative surgery. Both operations are used to repair fractures in the main body of the vertebra. Kyphoplasty is actually a type of vertebroplasty.

Vertebroplasty is the injection of bone cement into the fractured vertebral body. A long, thin needle is inserted through the skin into the bone. The cement is injected through the needle into the bone.

With kyphoplasty a deflated balloon is put through the needle into the fractured bone. The balloon is inflated to restore the size and shape of the collapsed bone. Then the bone filler cement is injected. With the kyphoplasty, the some of the height of the bone is restored.

Both methods are very technical. High quality imaging equipment is needed to perform these operations. The advantage of the kyphoplasty is improved spinal alignment. There’s also less chance the cement will leak into the body causing other problems.

Not necessarily. Some patients have more than one fracture that needs repair. Some patients develop new fractures after the first one is repaired. Other complications such as infection, abscess, or cement leak can also cause problems.

It’s best to have a doctor re-evaluate your uncle. He may just need more time to heal. He may need an exercise program to strengthen the muscles around his spine to help improve his posture. Or he may need a second vertebroplasty.

Early diagnosis and treatment is the key to preventing further problems. Don’t delay in calling the doctor’s office and letting them know what’s going on.

There are many problems reported in medical studies from unrepaired vertebral compression fractures (VCFs). Let’s start with the first, most common problem–pain. Not everyone has pain with VCFs but most people do. Pain disrupts sleep, decreases function, and is linked with depression.

If the bone collapses, spinal deformity can occur. The result may be a loss of the normal spinal curvatures. The spine starts to curve forward called kyphosis. The patient becomes bent forward. This position reduces the chest and abdominal cavities where the vital organs are located.

The stomach, intestines, lungs, and heart can’t function at their best when they are compressed. Pneumonia, constipation, loss of appetite, and reduced cardiac output are just a few problems that can occur. Some of these problems can cause death.

The discs, the vertebral bodies, and the neural arch normally absorb compression and load on the spine. The neural arch is a bridge of bone that forms a circle around the spinal cord to protect it.

There is a certain amount of natural degeneration that occurs in the spine starting at age 50. Bone density is less as the bones become more osteoporotic.

In elderly spines the neural arch (instead of the vertebral body) takes up to 90 percent of the compressive force. The discs tend to thin out as we age and don’t help absorb the shock as much.

The result is that when the spine is bent forward most of the pressure in on the front of the vertebral body. When the spine is extended most of the pressure is on the back half of the vertebra. Fatigue, aging, and gravity have a tendency to bring the spine into a forward flexed posture. The right angle and the right amount of force can result in a vertebral fracture.

All of these things can contribute to a vertebral compression fracture even in otherwise healthy adults.

This is a decision each individual must make for him or herself. Pain tolerances vary from person to person. For most people, the pain of a vertebral compression fracture is very disabling. It takes four to six weeks (or more) before the spine heals itself.

During the recovery time there is a tendency to stay in a forward bent position to help ease the pain. Healing in this position will cause more problems later with increased pressure on the spine and compressed organs in the chest.

Most people get immediate relief from pain with a vertebroplasty. There are even studies that suggest the cement injected into the fractured bone helps restore some of the strength and stiffness needed for normal spinal movement.

Giant herniated thoracic disc (HTD) is a real term used to describe a disc that is taking up at least 40 percent of the spinal canal.

There is a real danger of spinal cord injury with this type of disc problem. Surgery is often advised. Results vary depending on the size and location of the disc problem.