Vertebroplasty After a Painful Spine Fracture

spine fracture

When a painful fracture from osteoporosis occurs in the spine, a procedure called vertebroplasty may be considered. Vertebroplasty is a minimally invasive treatment option designed to help reduce or eliminate pain caused by collapsed vertebra. With this procedure, low viscosity cement is injected directly into the collapsed vertebral body under high pressure, with the goal of stabilizing the fracture and relieving the associated pain (caused by spinal bones rubbing together). Vertebroplasty can also help prevent further collapse of the vertebra and thus helps prevent further deformity (such as spine curvature and/or loss of height). This procedure was developed in France in 1984 and was first introduced in the U.S. in 1994.

Osteoporosis Causes Spine Fractures

Osteoporosis is a "silent" disease that affects 44 million Americans - 80 percent of whom are women. The condition is characterized by deterioration of bone tissue, which weakens the bones and makes them susceptible to fractures. The elderly population is at greater risk and many people are unaware they have osteoporosis until they experience a fracture, typically in the hip or spine. Many spinal compression fractures are undiagnosed, and people suffering from a fracture may believe their back pain is just a part of aging.

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Osteoporosis is the leading cause of vertebral compression fractures - injuries that occur when bone tissue inside the vertebrae of the spine breaks and then collapses, sometimes causing severe pain. Vertebral compression fractures affect approximately 750,000 people each year,1 and can occur even when doing simple activities, like bending or twisting.

In addition to chronic or severe pain, women who suffer from vertebral compression fractures may lose height and develop a hunchback appearance, which is sometimes called a "dowager's" or "widow's" hump. This can put pressure on the spinal cord and may lead to numbness, tingling, or weakness. Other symptoms include decreased lung capacity and sleeping difficulty. Any one or combination of these symptoms can adversely affect an individual’s ability to function normally and significantly hinder one’s independence.

A single vertebral fracture significantly increases a person's risk of further fractures. With a fracture or fractures left untreated, patients may face a loss of independence that can lead to depression, sometimes referred to as the "downward spiral" of a combination of adverse physical, social, and psychological effects. This underscores the need for patients to know if they are at risk for or have osteoporosis, to aggressively treat their osteoporosis before a fracture occurs, and to talk to their doctor if they have unexplained back pain or suspect a spine fracture.

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Spinal Fracture Treatments

Typically, the first line of treatment for vertebral compression fractures is conservative therapy (non-surgical), which includes pain medication, calcium and vitamin D supplements, rest (but only for a short time period, as prolonged inactivity can lead to further bone loss), and external bracing. Pain from the spinal fracture can last for several months while healing, but if it heals well with conservative treatment the pain will usually improve significantly within a few days or weeks.

When pain from a vertebral compression fracture persists, surgery may be considered to repair the fracture. The two commonly used procedures for spine fractures from osteoporosis are vertebroplasty and kyphoplasty, but in rare instances, where the patient has significant loss of vertebral height, spine fusion surgery may be appropriate. Both vertebroplasty and kyphoplasty have been shown to decrease or eliminate the pain associated with vertebral compression fractures. Medicare and most private insurance companies cover both procedures.

Candidates for Vertebroplasty

Patients best suited for vertebroplasty are those with a painful, non-healing vertebral compression fracture, regardless of the age of the fracture (although the procedure is most successful for more recent fractures). Most patients experience these fractures due to underlying osteoporosis, but patients who suffer fractures due to tumors may also be eligible. Patients not considered for vertebroplasty include those who are having pain not related to a vertebral compression fracture, those who have an extensive fracture affecting surrounding structures, or who suffer from an infection in which case the infection would have to be adequately treated first prior to undergoing vertebroplasty.

References:

  1. National Osteoporosis Foundation fast facts page. National Osteoporosis Foundation Web site. Available at www.nof.org. Accessed March 21, 2005.
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Written by Huy M. Do, MD