New treatment for osteoporotic spinal fractures shortens recovery

Singapore — When a 70-year-old woman fractured her lower spine after a fall at home, doctors could have had to prescribe her painkillers and bed rest for up to a month.

That is, if she had undergone the traditional treatment method for spinal fractures.

She would also have had to wear a back brace for at least four weeks and rely on her family to care for her during the recovery period, said Adjunct Assistant Professor Pua Uei, consultant at Diagnostic Radiology at Tan Tock Seng Hospital (TTSH).

With the latest computed tomography or CT-guided corrective spinal surgery, the woman was up and about two days after the procedure.

new imaging technology

The elderly woman is one of 22 patients who have undergone a new treatment for osteoporotic spinal fractures offered at TTSH since last September.

Dubbed central stentoplasty, this minimally invasive procedure was pioneered by Adjunct Asst Prof Pua, who specialises in vascular and interventional radiology, and Adjunct Asst Prof Leslie Ng, a consultant at the hospital’s orthopaedic surgery department.

The doctors said the procedure was performed using a new imaging technology called the Cone Beam CT.

Real-time, 3D imaging technology is used to help the surgeon visualise the spine anatomy in detail, said Adjunct Asst Prof Pua. A 4mm-to-5mm incision is made in the lower back to allow a stent to be inserted. A small amount of bone cement is then injected into the fracture. Bone cement is a biologically compatible bonding material.

Said Adjunct Asst Prof Pua: “Once the bone cement sets, the fracture is stabilised and (it) prevents further collapse along the spine. The procedure has the potential for rapid pain relief, and reduces hospitalisation and the bed rest duration.”

He added: “We’ve modified the existing technique from two incisions, two instruments and two stents to one incision, one instrument and one central stent. This was made possible due to the new CT imaging technology that allows accurate placement of a central stent.”

Central stentoplasty is an updated version of the older-generation procedure, which is guided by 2D X-ray imagining techniques.

Patients typically need about two days to recover. They can opt to have it done as day surgery. The procedure costs about S$4,000 and is Medisave-claimable, said Adjunct Asst Prof Pua.

Suitable candidates include patients who are unable to get pain relief from medication or are unable to tolerate conventional treatment methods such as bracing.

“With elderly patients, prolonged bed rest and immobility can have associated problems too. Local patients might also find it difficult to use a back brace due to our humid weather and the bulkiness of the brace,” said Adjunct Asst Prof Pua.

People who have had a spinal fracture have a higher risk of getting another, he added.