Over the years, our lifestyle has evolved significantly. Physical exertion required for daily activities (ADLs) has decreased dramatically. For instance, walking to the grocery store has been replaced by online shopping. While the food we consume today may look and taste appealing, it often lacks essential nutrients. Many of our foods are genetically engineered for mass production, prioritizing quality for sale over nutritional value. As a result of medical advancements, life expectancy has increased, with more people living into their 80s and 90s, leading to a growing elderly population. In recent decades, healthcare has increasingly focused on the needs of the geriatric (aged) population. With this introduction, I will discuss the issues related to weak and brittle spines in the elderly in this article, the second in the series: "A Stitch in Time Saves Nine."

Bones are composed of an outer hard shell called the cortical bone, which encases the sponge-like network of trabecular bone, known as cancellous bone. When the thickness of the cortical bone and the density of the spongy cancellous bone decrease, overall bone mass diminishes, making the bones brittle and susceptible to fractures.

Osteoporosis or weakened bones, is a natural process that occurs with aging. The term "osteoporosis" literally means "porous bone." While it cannot be entirely prevented, it can be delayed and its severity reduced, thereby minimizing the suffering it causes. Bones, though hard, require traction from muscles, proper nutrition, hormonal balance, an active lifestyle, physical activity, and rest to remain strong. Many of these prerequisites can be managed by individual effort, but hormonal imbalances require medical attention. Weak bones lead to fractures, delayed healing, and, in some cases, the progression of fractures into non-union and deformity, particularly in the elderly. Osteoporosis is often called a "silent disease" because it usually goes unnoticed until a bone breaks, typically in the hip, spine, or wrist.

This article focuses on osteoporosis of the spine, the body's central support structure. The spine is a weight-bearing structure that is used constantly in all body postures. It consists of multiple bones linked together with intervertebral discs, which act as natural shock absorbers. The individual vertebrae are bound together by ligaments and supported by muscles, often referred to as "core muscles." The spinal cord, a bundle of nerves, runs from the brain through the spine and connects to the body via peripheral nerves. Osteoporosis increases the risk of spinal fractures, which can severely impair mobility and cause intense pain.

Osteoporotic Fracture of Spine: often lead to a hunchback and reduced height in elderly individuals. These changes result from multiple fractures in the spinal bones, causing a decrease in overall height and sometimes leading to spinal deformities such as a hunchback. This condition is more common in women, as bones tend to weaken after menopause. Multiple childbirths and chronic neglect of nutritional needs (a common scenario where mothers save their favorite foods for their children and family without enjoying them themselves) make women particularly vulnerable to osteoporosis.

Spinal fractures do not heal as easily as fractures in other parts of the body. Proper alignment of fractured bones typically requires rest, but the spine remains active during rest, sitting, standing, or any other posture. Additionally, it is impossible to immobilize the spine with a cast as we do with limb fractures. The braces provided offer less than 20% stability. The larger issue is spinal instability, which can lead to spinal cord injury and paralysis—a devastating and irreversible condition.

Osteoporotic spinal fractures are common in the elderly, and with increasing life expectancy, public awareness of osteoporosis and these fractures is crucial.

Even a minor fall—or sometimes an unnoticed incident—can result in a fracture due to the spine's weight-bearing function. For example, the jolt from a speeding bus or car hitting a speed bump or pothole can cause a spinal fracture in an elderly person with osteoporosis. The usual clinical presentation is severe pain at the fracture site, often leaving the person bedridden. The pain may also radiate along the nerve root distribution. While bed rest often alleviates the pain, any movement brings it back with full intensity. After about 4-6 weeks, once the fracture heals, the pain subsides. However, prolonged bed rest further weakens the bone. Being bedridden for six weeks is no easy task, especially in today’s fast-paced world. Since the fracture is subjected to physical forces, especially body weight, healing often results in a reduced height of the spine. Over time, this reduced height and angular shape of the bone lead to deformities such as a hunchback.

The modern-day Solution:

The suffering from osteoporotic spinal fractures can be alleviated through a simple percutaneous needle procedure called kyphoplasty. In this procedure, a silicone balloon is inserted into the fractured spine to create space within the spongy part of the vertebra, surrounded by dense bone. This space is then filled with acrylic (bone cement) to strengthen the vertebra. Kyphoplasty is a quick, minimally invasive day-care procedure, allowing patients to return home the same evening, pain-free and walking! This technique has been practiced for the last couple of decades. Unfortunately, fear of surgery prevents many from seeking medical attention. This article aims to raise public awareness of kyphoplasty, an excellent example of a minimally invasive procedure that can significantly reduce pain and suffering.

However, if the fracture is not addressed promptly and progresses further, it can compress the spinal cord, leading to spinal cord injury and paralysis. If the fractured bone is pressing on the spinal cord, kyphoplasty is not an option. In such cases, a major open spinal surgery with titanium screws and rods is required. What could have been a simple day-care procedure turns into a weeks-long recovery process.

Kyphoplasty is that single stitch that can save nine actual stitches over the spine!