Sunday, January 4, 2009

Is it dangerous to treat fractures conservatively?

Until recently, conservative therapy (bedrest and pain medications) was the only option for treatment of vertebral compression fractures (VCF). With recent developments of procedures known as vertebroplasty and kyphoplasty, this has changed.

These procedures have a high success rate for pain relief, approaching 100%. Yet, unfortunately, a lot of doctors and insurance companies haven't changed. They're ignorant of how amazing these procedures really are.

Although some fractures will heal on their own, most that aren't better in 2-4 weeks will continue to have at least some pain associated with them for months. By treating patients conservatively in the beginning, we give them a chance to heal the fracture on their own.

Many patients, however, have other factors--such as endocrine imbalances or vitamin D deficiency--that can impair thier ability to heal the fracture.

Also, immobilization, or being stuck in bed can cause rapid deterioration of health and can lead to various complications. The most common complication I see is muscle wasting, or deterioration of the muscles. This leads to weakness, decreased exercise tolerance and even makes patients more prone to developing back strain (injury to the muscles).

The most feared, and often fatal, complication of immobilization is pulmonary embolism or PE. A PE results from formation of a blood clot in the leg that breaks off and travels to the lung. Other common complications include bedsores, malnutrition, and depression.

The other mainstay of conservative therapy is pain medications. Many patients don't like to use the medications because they may feel drugged or they are afraid of getting addicted to the drugs. Although there is some risk, most patients who take them as prescribed will not get addicted. The most common complication for pain medications in the elderly is constipation, which can be serious.

The good news is that for patients with a VCF, vertebroplasty and kyphoplasty can also be safely performed by experienced doctors even in patients that are not candidates for surgery. This is especially helpful since many patients with a vertebral compression fracture (VCF) are older and more prone to having chronic diseases such as hardening of the arteries and lung disease. These diseases can predispose a patient to serious complications during surgery.

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