Cement eases fractures in back, suffering

By Mary Beth Faller
The Stamford Advocate
Bill Clark's back hurt so badly that he couldn't walk for more than a few minutes before he'd have to sit down. As a self-employed landscaper, that made work difficult.

Now, Clark can bend and lift - carefully - without pain since he underwent vertebroplasty, a one-hour outpatient procedure in which special body cement is injected into the back.

"The pain started in December and got worse," says Clark, of Stamford, Conn. "My season starts in April, so I'd better be ready for it."

After several tests and consultations with physicians, he was told he had four fractured vertebrae and osteoporosis of the spine, making him a candidate for vertebroplasty.

"When someone tells you they're going to stick a needle in your back, you don't want to hear about it," Clark said. "But the pain said, `Yes.' "

He was referred to Dr. Marc Hamet at Stamford Hospital, an interventional radiologist who performs vertebroplasty, which was developed in France in 1984 and imported to the United States about a decade later.

The spine is constructed of 33 doughnut-shaped bones called vertebrae, which run from the base of the skull to the tailbone. Fractured vertebrae are usually caused by osteoporosis but can sometimes be caused by stress, trauma or tumors. When the vertebra section fractures, it collapses into a wedge shape, which can cause excruciating pain. Often, patients have several compression fractures stacked on top of each other.

"(The vertebra) is one of the only bones in the body that can't be cast," Hamet said. "In the past, bed rest was prescribed, but this usually just makes it worse," possibly causing pneumonia, painkiller addiction or additional bone deterioration.

Candidates must have an MRI and CT scan to rule out disc disease or other conditions, which vertebroplasty cannot help.

During the procedure, the patient lies on his stomach and may have light sedation but not general anesthesia. The site of the injection is numbed. A giant X-ray machine is curved in an arc over the patient and projects images onto monitors a few feet away.

Hamet pushes a thin metal bone needle into the back and within the vertebra segment. He is continuously guided by the images on the monitors.

Then he begins mixing the cement powder, called Simplex, with a liquid agent and with barium sulfate powder, which makes the substance visible on the X-rays. He combines it in an enclosed tube that is attached to a vacuum in the wall because the liquid agent is carcinogenic if inhaled. He must work quickly because the compound dries in about 10 minutes.

Using a reinforced standard syringe, Hamet then injects the goop through the tube into the person's vertebra segment. He must be very careful not to let it get near the spinal cord or spinal nerves, or the nearby aorta and vena cava. "It's not for the timid," says Hamet, who trained with the doctor who brought the procedure from France.

Then the needle is withdrawn and the process repeated at another vertebra if needed. "They don't see the needle, and I'm numbing all the way down," he said.

That's it. The patient lies still for about two hours and goes home.

Hamet can inject two vertebrae in the one-hour procedure, so patients such as Clark who have more than two fractures must return. He had his second treatment two weeks after the first.

"There was a recovery period, but I'm 100 percent now," he says. "I don't do silly things like lift a thousand pounds."

Hamet has a prune-sized chunk of the plastic cement on his desk, and it's grayish white, very lightweight and extremely hard. The cement reinforces the fractured part of the vertebra. "Now that it's stabilized it will heal, but it doesn't really matter because the cement is taking the place of the bone."

Hamet sees great potential for the procedure. Up to a quarter of all women older than 50 have spinal fractures, and the affliction accounted for $13.5 billion in direct medical expenses in 1995, he says.

In addition, victims suffer pain, diminished mobility, urinary retention, insomnia, depression and respiratory distress.

Copyright © 2001 The Seattle Times Company