Ask the doctor: Would an injection of cement ease my back pain?

Dr Martin Scurr has been treating patients for more than 30 years and is one of the country's leading GPs. Here he answers your questions...

I have three fractures in my spine and have been offered vertebroplasty surgery. What do you think
of this procedure?
Mrs V. Dobbie, Farnham, Surrey

Making bones stronger: With vertebroplasty, 'bone' cement made of artificial plastic material is injected into a fractured vertebra

Making bones stronger: With vertebroplasty, 'bone' cement made of artificial plastic material is injected into a fractured vertebra

Dr Scurr says...

Poor you — I imagine that with three spinal fractures you have been having a miserable time with pain.

While painkillers such as morphine
or non-steroidal antiinflammatories
can help, sideeffects such as stomach pain can sometimes be intolerable, and the benefits may not be as good as
hoped in terms of pain control.

The most common cause of
fractures in the spine is osteoporosis,
or brittle bones.

Usually, this kind of fracture will heal eventually, though, of course, this does take time, and you have a life to get on with.

So should you have a vertebroplasty?

First, let me explain what’s going on with your back.

The spine consists of a series of bony blocks, or vertebrae. The vertebrae are hollow at the back — the spinal cord runs down this channel. There are seven vertebrae in the neck, 12 in the chest
(the dorsal spine) and five in the
lumbar region.

With osteoporosis, the bone structure becomes weaker and crumbly, causing the vertebrae to collapse and fracture.

This is more common in the lower half of the dorsal spine and the lumbar spine, as they have the greatest load to carry.

The crushed bone will heal with rest and time, but it will remain distorted, which is why some older people become shorter and hunched forwards.

With vertebroplasty, ‘bone’ cement made of artificial plastic material is injected into a
fractured vertebra to make the crushed bone hard and stable and so relieve the pain.

A large needle (almost as thick as a pencil) is inserted under general anaesthetic through the skin into the fractured vertebra.

The bone cement, a rapidly setting sort of glue about the consistency of toothpaste, is
cautiously pumped in (the whole process is monitored using X-ray technology).

There is a newer variation of vertebroplasty called kyphoplasty — a balloon is first inserted, using a similar needle, and then inflated to force the crushed vertebra to
expand, creating a cavity.


To contact Dr Scurr with a health query, write to him at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email — including contact details.

Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general

Always consult your own GP with any health worries.

The balloon is withdrawn and the cement is then pumped into the cavity. One of my patients had this done this year, at St Mary’s Hospital, Paddington.

Two of his vertebrae had collapsed and he was in considerable pain, but after vertebroplasty he was painfree the same day and did not need any more painkillers.

In my quest for further information, I discussed your letter with Anne Mitchener, a neurosurgeon who treats some patients by kyphoplasty. She described one patient, a woman in her 60s, who had three crush fractures and was in severe pain despite taking several types of painkillers (which were making her nauseous).

Following kyphoplasty she, too, was pain-free, and described her life as ‘transformed’.

However, there are potential complications: the bone cement must not be allowed to leak into the spinal canal where it could damage the spinal cord or nerve roots.

So the procedure needs to be done by someone with skill and experience.

And then there are the results of a large trial of vertebroplasty that compared the procedure with a placebo — half the patients had the cement injected, half went through the whole process, but without any actual cement being used.

The genuinely treated group were no better off after six months than those who’d received the sham treatment and who’d recovered spontaneously (although
possibly were in pain for longer).

You do not have an easy decision, but if you want rapid pain relief rather than relying on painkillers for many weeks, the operation does seem an attractive option.

My children (aged six and three) keep getting ear infections when we return from holidays and they've been playing in the swimming pool. Are there any ear drops I can administer as a preventative measure?
Ann Weekly, by email 

Dr Scurr says... This is not an uncommon problem — we see many patients
throughout the year with this.

‘Swimmer’s ear’, ‘surfer’s ear’ or otitis externa, to give it its technical name, is inflammation of the skin of the ear canal. It is usually due to bacterial infection as a
result of water getting in there.

The skin lining the canal is particularly vulnerable. It sits between the cartilage in the outer part of the ear canal and bone in the inner part, with no cushioning of fat.

This may make it more liable to damage, such as when trying to dry the ear with a screwed up corner of a towel or even a cotton bud — forbid your children to do either.

Interestingly, the problem occurs not just in the sea but also with pools that you might think would be cleaner. That’s because it’s not bacteria in the water that’s the issue — rather the water knocks out the ear’s natural protection against germs that are always
around anyway.

The ear canal lining produces ear wax, which is acidic — nature’s way to help prevent infection. Pool water, which is alkaline, may neutralise this.

Such infection can be extremely painful and difficult to eradicate, which is why you want to stop this happening in children as susceptible as yours.

It’s not clear why some people are more prone, though perhaps their ear canals don’t dry out as effectively.

First, you need to keep the ear canal as free of water as possible: the only way to do this is to use cotton wool earplugs, which you make yourself using petroleum jelly to keep them waterproof.

This works well — I think rather better than commercially available rubber/plastic earplugs — but needs diligence with children constantly in and out of the water.

Commercial earplugs interfere with their hearing, which is not ideal, but it’s a matter of weighing up the pros and cons.

Second, make sure the ear canals are as dry as possible at bedtime by using a hairdryer, set on the lowest heat, blowing directly into the ear from a few inches back.

Never use cotton buds, or anything else, to dry out the ears.

As a preventative, acetic acid drops or spray (eg EarCalm), which your GP may agree to prescribe, can be invaluable if used every night.

Acetic acid — found in vinegar — is not toxic and, when used in ear drops, it ensures conditions in the ear canal are as acidic as nature intended. Good luck!

By the way... Why does the NHS still listen to these dinosaurs?


Do children get a bad deal from their GPs?

Professor Sir Ian Kennedy was commissioned by the last government to investigate this and has just published his report.

I wish I could say I thought it was good, but this expert has made a brilliant job of totally failing to get to grip with the subject.

Sir Ian’s view is that pockets of  excellence exist, but as islands in a sea of mediocrity. As he sees it, most GPs have little or no experience of paediatrics as part of their training and the healthcare of children is a low priority for them.

He makes this wild statement having spoken, it appears, to only one GP and visiting
one general practice.

And yet he admits the healthcare of children is typically 40 per cent of the workload of a GP and that a pre-school child will visit their family doctor six times a year.

The medical care of children is a low priority? Bonkers!

The fact is that a would-be GP spends a year of the three years in post-graduate study
working in general practice — where 40 per cent of the workload is paediatric medicine.

Many of those young, would-be GPs have already held a six-month tenure as a junior
hospital paediatrician. Then there is the Red Book, the health passport that all mothers are given when their children are born.

This document is carried by the parent and is of great value because it records a linear history of the healthcare of the child, detailing immunisations, developmental records of growth and notes about health problems and progress: it is a vital resource.

Yet Sir Ian says: ‘Failure to share information among those coming into contact with the child is one of the most serious shortcomings of current arrangements... data in many areas of healthcare for children is poor or non-existent... this must change.’

I suggest the author of this ill-informed and poorly researched report decided his conclusions at the start — and then wandered about gathering the data to rationalise his views.

The problem is that policy-makers and those in power may listen to and even act on the views of such so-called experts.

When I was chairman of the Independent Doctor’s Federation, the body that represents the opinions and expertise of non-NHS doctors, I spent three years attempting to speak to or meet with Sir Ian, then chairman of the Healthcare Commission, our inspectorate.

He managed to completely avoid me. He was not available to listen to evidence then — and he has listened only selectively to evidence in his latest commission.

Maybe he has an aversion to actually speaking to doctors? Perhaps this is one old dinosaur that needs to be put out to grass.

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