Becker's Spine Review

15 EXECUTIVE BRIEFING SPONSORED BY V ertebral compression fractures due to osteoporosis cause debilitating pain that can severely limit activity and quality of life. Unfortunately, these injuries are often challenging to diagnose and treat. In 2019, a multi-specialty panel of physicians convened to standardize and streamline care recommendations for VCF patients, using the RAND/UCLA Appropriateness Method to develop patient-specific recommendations for a VCF clinical care pathway. 1 Physicians who have seen the benefits firsthand of the VCF care pathway have advocated for the recommendations. This advocacy includes building awareness within institutions among administration and staff, as well as educating referring physicians and colleagues in the broader community. Early VCF intervention begins with increased awareness in the medical community Avery Jackson III, MD, founder, CEO and medical director of Michigan Neurological Institute in Grand Blanc, discussed the benefits of early intervention for VCFs via minimally invasive surgical procedures with Becker's Spine Review. He also discussed his work as a pioneering VCF educator. Vertebral compression fractures are a common problem facing older adults. They occur between 750,000 and 800,000 times a year in the U.S. 2 "When people go undiagnosed and untreated, they develop multiple fractures, fall and can develop pulmonary function issues," Dr. Jackson says. "This is particularly concerning in the current COVID environment." The key to early intervention is getting medical practitioners thinking about osteoporotic fractures when faced with a patient's presenting symptoms in the office, clinic or emergency room. "Providers should be suspicious when a patient has pain in the thoracic or lumbar spine. Taking a simple lateral X-ray is a good place to start and it's an inexpensive option." Michigan Neurological Institute – Great Lakes ECHO brings VCF education to community To promote awareness of VCFs, advocacy groups such as the Bone Health and Osteoporosis Foundation and American Bone Health have launched education outreach programs directed at clinicians and the general public. In his own community, Dr. Jackson has developed continuing medical education events that facilitate an open dialogue among primary care physicians, hospitals, urgent care centers and other key stakeholders. MNI – Great Lakes ECHO (Extension for Community Health Outcomes) is the first Bone Health ECHO project in the state of Michigan and the second in the world. Sanjeev Arora, MD, started Project ECHO in 2003 at the University of New Mexico in Albuquerque to help expand specialty care in the state through digital collaboration. In 2017, Dr. Jackson helped establish the program in Michigan to improve communication and best practices among clinicians and physicians at the university and community levels. "We leverage telecommunication technologies like Zoom and engage in dialogue with experts in the field," Dr. Jackson said. "We connect clinicians across the state, the country and even the world. We've had people as far away as Galway, Ireland, join the monthly MNI – Great Lakes ECHO discussions." The goal of MNI – Great Lakes ECHO is to educate community clinicians so they can become more expert at treating bone health with preventative care. With osteoporosis, that means mitigating the risk of fracture or fixing fractures as early as possible. "We know that vertebral compression fractures are harbingers of more fractures, if we aren't aggressive," Dr. Jackson said. "Vertebral augmentation is the placing of a balloon or other device to raise up the fracture and then fixate it with cement or other substances to make it stronger. One of the big misconceptions is that if you repair a collapsed osteoporotic fracture of a vertebral body, the patient will develop adjacent level fractures. In reality, that's not true." Studies have shown that patients with VCFs treated with vertebral augmentation did not show an increased rate of additional symptomatic adjacent-level VCFs when compared to a non-operative control group. 3,4 Dr. Jackson said many mistakenly assume that when one bone breaks, the others will collapse like a house of cards if the broken bone is repaired. "In our practice, we have found that that the opposite occurs," he said. "If the disk spaces are normal, when you reinforce the fractured vertebra with inner strength, you actually protect the adjacent level from fracturing. This concept is important to understand, but it's not discussed a lot." Hands-on examinations are essential for identifying the right candidates for vertebral augmentation According to Dr. Jackson, a good candidate for vertebral augmentation meets several criteria. Individuals are typically over the age of 50 and have suffered a fall or trauma from standing height. They also have an obvious fracture based on radiologic evidence that results in a 15 percent to 20 percent height loss. Finally, they are symptomatic, with pain on examination at the fracture level. "To give the patient the best outcome we really need to have 'hands on.' Some individuals may have a fracture that's not Early intervention for vertebral compression fractures starts with provider education Insights from MNI – Great Lakes ECHO

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