When a vertebral compression fracture develops in the spine and causes back pain, a minimally invasive surgery called vertebroplasty may be considered. This article discusses who may benefit from vertebroplasty, the details of the procedure, and potential risks.
How a Vertebroplasty Can Treat a Compression Fracture
A vertebral compression fracture occurs when the vertebra cannot fully support its load and starts to collapse due to tiny cracks forming in the bone. Typically, the front of the vertebra starts to collapse and begins to take a wedge shape. The collapsing part of the vertebra must lose at least 15% of its normal height to be considered a compression fracture.
Most commonly, these fractures occur in older people who have osteoporosis, but they can also occur due to other causes, such as bone cancer or a high-impact trauma.
A vertebroplasty involves carefully guiding a needle through a small puncture in the back and into the damaged vertebra. Once the needle is positioned within the vertebral compression fracture, bone cement is delivered into the tiny cracks. The cement fills the cracks and eventually solidifies, which eliminates the pain source by stabilizing the vertebra and preventing further collapse.
When to Consider Vertebroplasty
Most vertebral compression fractures can be treated without surgery. However, vertebroplasty may be considered if the following are true:
- Significant pain has persisted at least 2 weeks. If pain does not start to get better within a week or two, surgery to stabilize the compression fracture might bring quicker pain relief than other methods. Vertebroplasty is typically performed 4 to 6 weeks after the fracture has occurred.
- Pain worsens with axial load. If pain increases when weight is placed on the spine from above, such as when getting out of bed or carrying a heavy item, it is more likely that the vertebral compression fracture is actually the pain source and would thus respond favorably to a vertebroplasty procedure.
- No associated neurologic deficits. If any part of the bone is pushing against the spinal cord or a nerve root and causing neurological deficits, such as tingling, numbness, weakness, and/or problems with coordination, vertebroplasty is unlikely to relieve these signs and symptoms.
- No significant kyphosis or other spinal deformity. Vertebroplasty essentially cements the vertebra in its current position, which works fine if the spine is close to its normal shape. However, if one or more vertebral compression fractures have caused the spine to curve too far forward (kyphosis), a different surgery, called kyphoplasty, may be recommended. Kyphoplasty is similar to vertebroplasty, except that it helps restore the damaged vertebrae closer to their normal height, which can correct a kyphosis deformity. With other types of deformity, a different surgery may be needed, such as a fusion.
- Fracture has not already healed. If the compression fracture has already healed, vertebroplasty is unlikely to help reduce pain.
In addition, the patient must be healthy enough for surgery. For example, if a bone infection is present, or if surgery would not be well tolerated, the procedure should be avoided.
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Efficacy of Vertebroplasty
The medical literature has mixed results regarding the efficacy of vertebroplasty, with some studies finding the procedure to be effective while others have been inconclusive or even advised against it.1-2 Most of the current literature suggests that, compared to nonsurgical treatments, vertebroplasty may be effective at relieving pain and improving function more quickly.
There is also a growing body of evidence that vertebroplasty (and kyphoplasty) may help older people who have sustained a vertebral compression fracture to live longer.3-4 The reason for this is not yet known and more studies are needed.