Spinal compression fractures are often seen in older adults and are usually caused by osteoporosis. The fracture occurs in the vertebral body due to compression forces from above and below.
Treatment for spinal compression fractures include conservative care such as physical therapy and, in more advanced cases, surgical intervention may be considered.
In this article, we look at the diagnosis and treatment of spinal compression fractures along with two surgical procedures: vertebroplasty and kyphoplasty.
What Is A Spinal Compression Fracture?
Here’s an article on compression fractures presented by the UCLA Spine Center. The article includes 2 videos related to diagnosis and treatment.
Compression Fracture of the vertebral body is common, especially in older adults. Fractures are usually caused by osteoporosis, and range from mild to severe. Vertebral compression fractures occur when the weight of the upper body exceeds the ability of the bone within the vertebral body to support the load. Generally, a compression fracture is the result of some type of trauma. More severe osteoporosis can allow fractures to develop from even minor trauma. Up to 30 percent of compression fractures occur while the patient is in bed.
Symptoms: Spinal compression fractures can be insidious and may produce only modest back pain early in the course of progressive disease. Over time, multiple fractures may result in significant loss of height. Progressive loss of stature results in the shortening of the paraspinal musculature requiring prolonged active contraction for maintenance of posture, resulting in pain from muscle fatigue. This pain may continue long after the initial fracture has healed. Patients develop thoracic (mid back) kyphosis and lumbar lordosis (sway back) as vertebral height is lost. More severe fractures can cause significant pain, leading to an inability to perform activities of daily living, and a life-threatening decline in the elderly patient who already has decreased reserves.
Diagnosis: Only about one-third of vertebral fractures are actually diagnosed, because many patients and families regard back pain symptoms as arthritis or a normal part of aging. Therefore, a compression fracture should be suspected in any patient older than 50 years with sudden onset of mid- or low-back pain. Most patients will remember a specific injury as the cause; however, fractures may occur without any history of increased force on the spine. While the diagnosis can be suspected from history and physical examination, plain x-rays, as well as a CT scan or MRI, are often helpful in accurate diagnosis and prognosis. (Full article and videos here)
What Are Kyphoplasty and Vertebroplasty?
Here’s an article published by Spine universe and written by Jean-Jacques Abitbol, MD; and reviewed by Edward C. Benzel, MD and Jason M. Highsmith, MD.
Vertebroplasty was originally developed in France in 1986 and has been further refined and available in the US since 1991.
Vertebroplasty is a minimally invasive, non-surgical procedure that is designed to relieve the pain of compression fractures. Vertebroplasty literally means fixing the vertebral body. In addition to relieving pain, those vertebral bodies that are weakened but not yet fractured can be strengthened, thus preventing future problems.
How is Vertebroplasty Performed?
Under general anesthesia, or sometimes under sedation, a special bone needle is passed slowly through the soft tissues of the back. Image guided x-ray, along with a small amount of x-ray dye, allows the position of the needle to be seen at all times. A small amount of orthopaedic cement, called polymethylmethacrylate (PMMA), is pushed through the needle into the vertebral body. PMMA is a medical grade bone cement that has been used for many years in a variety of orthopaedic procedures.
The cement is sometimes mixed with an antibiotic to reduce the risk of infection, and a powder containing barium or tantalum, which allows it to be seen on the x-ray. When the cement is injected, it is like a thick paste, but it hardens rapidly. Usually each vertebral body is injected on both the right and left sides, just off the midline of the back.
Within a few hours, patients are up and moving around. Most go home the same day.
Kyphoplasty is a newer treatment for patients immobilized by the painful vertebral body compression fractures associated with osteoporosis. Like vertebroplasty, kyphoplasty is a minimally invasive procedure that can alleviate up to 90% of the pain caused by compression fractures. In addition to relieving pain, kyphoplasty can also stabilize the fracture, restore height, and reduce deformity.
How is Kyphoplasty Performed?
Kyphoplasty is performed under local or general anesthesia. Using image guidance x-rays, two small incisions are made and a probe is placed into the vertebral space where the fracture is located. The bone is drilled and a balloon, called a bone tamp, is inserted on each side. These balloons are then inflated with contrast medium (to be seen using image guidance x-rays) until they expand to the desired height and removed. The balloon does not remain in the patient. It simply creates a cavity for the cement and also helps expand the compressed bone.
The spaces created by the balloons are then filled with PMMA, the same orthopaedic cement used in vertebroplasty, binding the fracture. The cement hardens quickly, providing strength and stability to the vertebra, restoring height, and relieving pain. (Read full article)
Medical Research Questions Benefits of Kyphoplasty and Vertebroplasty
Kaiser Health News published an article by Merrill Goozner, a writer for The Fiscal Times, on the rising costs of healcare being related to surgical devices.
“Requiring evidence of benefit of effectiveness for patients before device approval would prevent billions of dollars from being spent on technologies that are not helpful for patients and are even harmful,” said Rita Redberg, editor of the Archives of Internal Medicine and a cardiologist at the University of California, San Francisco. “There are many examples, such as vertebroplasty and kyphoplasty for back pain [compression fractures], on which Medicare spends approximately $1 billion annually. After they were FDA-approved, randomized clinical trials showed they were no more effective than a sham procedure in relieving symptoms.” (Read full article)
Do you have additional questions about compression fractures, vertebroplasty, or kyphoplasty? We have specific Patient Guides that discuss each in more detail. If you would like access to this informative and easy to understand Patient Guide, just click this link and we’ll make sure you get your copy today.
Patients’ Guide To Compression Fracture, Kyphoplasty, and Vertebroplasty
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