Advanced Treatment for Vertebral Fracture

A 57-year-old patient presented to Aster Hospital, Al Qusais following an earlier diagnosis of L4 compression fracture with a collapse for which surgery was advised.

Fractured and collapsed vertebra at L4 (approx. 15cm deep from skin surface)

Fractured and collapsed vertebra at L4

The patient who suffered a fall at home was admitted with severe back pain and was unable to walk or stand. Weighing over 200kgs, the patient had other multiple comorbid factors like Diabetes, HTN, Bronchial asthma and allergies. Her imaging was thoroughly analyzed, and further imaging was acquired. Treating neurosurgeon, Dr Chelladurai Pandian Hariharan emphasized, “An open surgery decompression and pedicle screw stabilization would have been a high-risk procedure considering the comorbidities of the patient. Since the posterior cortex of the vertebral body was intact, the patient was planned for a minimally invasive procedure.” Post medical fitness examination and obtaining the patient’s consent, she was taken for Kyphoplasty and Vertebroplasty.

Vertebroplasty and Kyphoplasty are safe and effective surgical techniques involved in the treatment of vertebral body compression fractures. Vertebroplasty concerns the percutaneous injection of bone cement – PMMA cement – into the cancellous bone of a vertebral body.  Kyphoplasty involves an inflatable balloon to create a cavity for the cement with the additional potential goals of restoring height and reducing kyphosis. Both procedures are effective treatment options for the reduction of pain associated with vertebral body compression fractures. Biomechanical studies demonstrate that Kyphoplasty is initially superior for increasing vertebral body height and reducing kyphosis.

Post-op, the patient suggested that her pain had significantly reduced. She had also regained power in her right LL. The following imaging was found to be satisfactory with the restoration of height and no extravasation. Simultaneously, physiotherapy was initiated – the patient was able to sit comfortably and was mobilized with support. She was discharged in a stable state and on follow up, she could stand with support, without pain.

Post Vertebroplasty – height restored

Post-follow up, the patient’s relatives expressed immense gratitude to the team and we’re thrilled to witness the patient regain and restore her mobility.

Dr. Hariharan further reiterated, “It is the availability of advanced equipment like a microscope, high-end spinal drill system and C-arm which enable us to perform such complex procedures at our facility. Also, the availability of on-demand Neuromonitoring and Neuronavigational systems makes the surgical procedures even safer.”

Post vertebroplasty
Dr Chelladurai Pandian Hariharan
Specialist Neurosurgeon
Aster Hospital, Al Qusais