Tuesday, April 5, 2011
Life or Death - Fixing Your Fracture
I continue to be amazed by the attitude taken by many spine surgeons regarding fixation of vertebral fractures. I can only assume that they are either uneducated or callous.
On a daily basis I hear local surgeons opine (either directly or indirectly through my patients) that vertebroplasty and kyphoplasty 'don't work', that fractures get better by themselves and that having a fracture 'won't kill you'. Although I would prefer that other doctors listen and modify their behavior, I continue to try to do the best thing for the patient. The truth is that people die of vertebral fractures--and they die for many reasons.
I can remember as an intern in internal medicine at the VA Medical Center in Oklahoma City being taught by our house officer that if a veteran came in with a vertebral fracture, that their likelihood of death was roughly equivalent to a patient being admitted for congestive heart failure or pneumonia. Yet, the next year in radiology residency, I was instructed by multiple board-certified radiologists to 'ignore those fractures' because 'they all have them.' I can't think of a more poignant contrast in knowledge and ignorance when it comes to training physicians to treat patients with osteoporotic vertebral compression fractures.
Today I would like to draw attention to yet another article showing the benefits of treating these fractures, rather than ignoring them--a recent article published in the Journal of Bone and Mineral Research (JBMR). The authors looked at death rates in 858,978 Medicare patients who were diagnosed with vertebral compression fractures. Those who underwent treatment with vertebroplasty or kyphoplasty were 37% less likely to die in the next 4 years.
There are many reasons why people die after a vertebral fracture. They often are immobilized, laid up in bed and unable to get around. They become weak and deconditioned. They develop blood clots in the legs that can travel to the heart and lungs (pulmonary embolus). They get bedsores. They get depressed and lose the will to live because of constant pain. Perhaps worst of all, fracture pain prevents them from living a normal life and stops them from doing the things that they love--the very things that make life worth living.
So, if you or a loved one suffers a vertebral fracture, this study suggests that if it is NOT treated, then you or they are 37% more likely to die in the next 4 years than if it was treated.
Yet again, more proof positive that interventional specialists who treat these fractures are on the right track. Everyday by fixing these vertebral fractures, they are not only taking away the pain, they are saving lives. Meanwhile, the doctors who continue to deny the efficacy of these procedures do so at the peril of their own patients.
Edidin A, et al. Mortality Risk for Operated and Non-Operated Vertbral Fracture Patients in the Medicare Population. JBMR, 2011: Feb 9. DOI: 10.1002/jbmr.353