Vertebral stentoplasty, as the procedure is called, is slowly making its presence felt in India where about 10% of the population develop osteoporosis, a disease that makes the bones thinner and prone to fractures. Osteoporotic fractures could cause disability among the elderly, more among women than men.
“My father was in a taxi, travelling from Kalyan to our new house in Thane, when it sped over a speed-breaker without slowing down,” said the patient R Shinde’s son (name changed on request). Shinde was tossed around in the seat, and developed severe backache by the time the journey ended. Scans showed a fracture in the spine – an indicator of osteoporosis – that local doctors said would heal on its own with bed rest.
“The accident occurred in April and, within three months, Shinde could barely stand up,” said spine surgeon Dr Priyank Patel from Jupiter Hospital, Thane, who placed the stent in the patient.
While Shinde knew he had high blood pressure and diabetes, diagnosis of severe osteoporosis was new. “Osteoporosis is an epidemic among the elderly, and there is a good treatment in the form of injections available but people are unaware of both,” said Dr Patel.
The conservative treatment for osteoporotic fracture is bed rest, but a small section could need cementing of the fracture to heal. “However, long-term studies have shown that the cement could, at a later date, move or leak. As Shinde also has some neurological issues, we suggested that a stent would help the cement stay firm,” said Dr Patel.
In stentoplasty, a scaffolding-like stent made of titanium is inserted into the collapsed/fractured vertebra. “The cage is then expanded inside, lifting the collapsed bone before bone cement is added around it,” he said.
Shinde started walking on his own within 24 hours. His son said, “For two months, my father had to lay on bed as he was in pain if he sat or stood up. He is now walking as much as possible as per medical advice,” he said.
However, spine surgeon Samir Dalvie from Hinduja Hospital, Mahim, said the stent is not much of an advancement. “Most osteoporotic fractures among the elderly heal themselves, but a small percentage remain painful even after 6-8 weeks. Such patients are known to benefit from a procedure called vertebroplasty in which cement is injected in the vertebra through a needle. Vertebral stenting is a modification of the same where, in addition to cement, a metal stent is placed inside,” said Dr Dalvie. Stent achieves the same result as cement, but at expensive cost, he added.
A doctor of a public hospital said cementing a fracture costs Rs 8,000 but stent is expensive at Rs 1.5 lakh. “It is an industry-driven innovation only few patients need,” he said.
