Vertebral and Spinal Fractures: Doctor Answers Patient Questions

The following explanations, insights and advice about spinal fractures, vertebral fractures and compression fractures - including surgical options like Kyphoplasty and vertebroplasty - are provided by Peter F. Ullrich, Jr., MD, an orthopedic spine surgeon and Medical Director for Spine-health.com.

Patients frequently e-mail us questions about spine fractures and vertebral fractures, and while we don’t provide individual responses, periodically, Dr. Ullrich will take time to respond to the more frequently asked questions and we publish the responses in this section of the site.

Please understand that the following responses to questions about spinal fractures and vertebral fractures represent the opinion of one physician, and are intended for informational purposes only and not as a substitute for professional medical help or advice.

Vertebral and spinal fractures questions and physician responses

Question:

What is the difference between kyphoplasty and vertebroplasty with respect to the time limitations on the effectiveness of the treatments from the time of the bone fracture?

Doctor’s response:

Some practitioners believe a kyphoplasty is better suited to treating bone fractures older than three months because a reduction with the balloon can be achieved.

Besides reducing the spinal fracture with the balloon, the other principle difference between the two techniques is that the methymethacrylate (bone cement) is injected under high pressure with the vertebroplasty, whereas the kyphoplasty creates a cavity that the bone cement can be injected with little pressure. The higher the injection pressure, the more likely it is to extravasate into the canal or the venous system. Personally, as a spine surgeon, I would be very reluctant to perform a vertebroplasty in an older spinal fracture.

A better question is whether or not either procedure should be done for compression fractures older than six months. In these cases, I have obtained a bone scan with the thought that if there is increased bone turnover (the bone scan is “hot” at the fracture site), then stabilizing the fracture should help. If there is not increased activity at the site (the bone scan is “cold”), then the fracture would be assumed to be healed and no surgical intervention would be warranted.

Question:

On June 20, 2002, I suffered a fracture of my C-7 vertebrae by doing a somersault on a hard surface. I have seen a neurosurgeon who says we will play the “wait and see game.” I pretty much have broken off the whole spinal process and have some ligament damage. What are some of the health ramifications I could face by not having surgery to remove this bone fragment? Please note that I am a very active 32-year-old mom. I just completed a half marathon this spring.

Doctor’s response:

Without knowing which piece of the C7 bone you have broken, I cannot accurately advise you. However, it sounds as though you may have pulled off part of the C7 spinous process. This is a common injury and is known as a “clay shoveler’s fracture.” (When clay used to be shoveled by hand, the workers would pull up hard and tear off their spinous process). The spinous process does not impart any structural support to the spine and is not needed. Therefore, there is no reason to operate or remove this bone. The bone will not heal to itself, but will form a fibrous union. This is really more of a ligamentous injury than a bony injury and a bony union is not needed. It will hurt for months but the pain will eventually improve. Please ask your surgeon if this is a spinous process or a “clay shoveler’s fracture”.

Question:

I had a laminectomy 11 years ago, which seemed successful at the time. The surgery lasted many years (6 or 7) and now pain has emerged, suspected cause is pressure at the S-I joint. I have had many years of injections into the joint with minimal short term relief. I went to an orthopedic surgeon, who no longer works on backs, and he suggested another surgery separating the 2 joints with pins and fusion. I am now 60, and I don't want to go through that again. I have been seeing a chiropractor for several years now and I get decent temporary relief.

Pain is brought on by standing...I can ride a bike for twenty miles, and I just came off a trip where we were in the car for 10 hour days...no issues there. Sometimes I hang from a bar and the back will separate, giving temporary relief. Is there a chance that this kyphoplasty procedure would give me permanent relief?

Doctor’s response:

Kyphoplasty is a new procedure that is meant to repair osteoporotic vertebral body compression fractures. It does not sound as though this is what your pain is from so you would be unlikely to be a candidate for this.

If, over the years, you have developed any instability in the lumbar spine, then the only type of surgery that would be useful would be a fusion surgery. Otherwise, conservative treatment options like chiropractic and/or physical therapy may be helpful.

To find out if you are a candidate for a spine fusion you would really need to be seen by a spine surgeon (either ortho or neuro).

Question:

I am a 55 year old female who has comp. fractures at T7 and T8. My insurance company denied me kyphoplasty surgery, stating there has not been enough clinical data to support its success and Medicare is the only insurance to date that has paid my doctor to perform this procedure. Do you have any information to prove the success of this procedure and can you provide me with the names of any insurance company that has paid for this procedure other than Medicare? I am 12 wks into the fracture, so time if of the essence. Thank you.

Doctor’s response:

I do not have the references off-hand, but there are multiple articles that support kyphoplasty as an effective treatment for a compression fracture. I have been paid by three different insurance companies for the procedure, although in my state (Wisconsin), Medicare does not actually pay for the procedure.

Contact Kyphon, the company that makes the kyphoplasty device. They would have a list of the articles and can probably help you with reimbursement issues. If you have had pain for three months from an osteoporotic compression fracture, the procedure probably is indicated. However, it is not indicated if you have normal bones and the fracture is from a trauma.

What next?

If you have questions about spinal fractures or vertebral fractures, please use this site to find peer-reviewed health information about spinal conditions, diagnosis and treatment options. The quickest way to locate information on the site is to use the “keyword search” box located in the upper left hand corner of each page. Also, if you want to talk online with others who may be in a similar situation or exchange information with other patients with spinal fractures, please go to the Spine Forum Message Boards.

Additional disclaimer: Spine-health.com does not offer medical advice or treatment. This information does not replace the physician-patient relationship, and the information is not medical advice or treatment. It should only be considered as one physician's opinion based on an extremely limited amount of information. Patients should always seek the advice of a trained health professional for back pain or any health condition. Please note that the contents of this section have not been peer reviewed by Spine-health.com’s Medical Advisory Board.