What is a compression fracture?
The spine is made up of multiple bones called vertebrae. The thick portion of bone at the front of each vertebra is called the vertebral body, which provides the major support for the entire spine. This portion of the vertebra can fracture and collapse, which is known as a vertebral compression fracture (VCF).
Most VCFs are caused by osteoporosis but these fractures can also be caused by tumors that involve the vertebral body or by trauma. These conditions weaken the bone to the extent that everyday activities (such as carrying something or bending over to pick something up) can cause the bone to fracture. The pain associated with these fractures can be significant, and prevent people from carrying on their activities of daily living.
Once a vertebral body compression fracture occurs, the risk for having another fracture is increased significantly because the presence of a fracture affects the distribution of weight along the spine. This increases the stress on adjacent vertebral bodies, which puts them at risk for fracture. When multiple VCFs occur, the spine can begin to angle forward, resulting in a stooped posture which is known as kyphosis. Kyphosis has been associated with reduced activity and mobility, decreased appetite and sleep disorders, impaired pulmonary function, and decreased quality of life.
What is osteoporosis?
Osteoporosis is a condition in which bones become fragile and weak, causing them to fracture more easily than normal bone. Osteoporosis is said to be present in more than 50% of patients older than age 50. According to the National Osteoporosis Foundation, some people are more at risk for developing osteoporosis than others. The known risk factors for osteoporosis are listed below:
- Gender: Women have less bone tissue and lose bone more rapidly than men because of the changes involved in menopause.
- Age: One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime.
- Race: Osteoporosis poses a greater threat to Caucasian and Asian women, although African American and Hispanic women are also at risk.
- Body Type: Women who are small-boned or thin are more susceptible to osteoporosis.
- Genetics: If a parent or sibling had osteoporosis, your likelihood for developing the disease is increased.
- Lifestyle: A diet low in calcium and a sedentary lifestyle can contribute to the development of osteoporosis. In addition, smoking and alcohol abuse are considered risk factors. Vitamin D deficiency can also increase risk.
- Medication: Certain drugs, especially steroids and those drugs used for rheumatoid arthritis and gastrointestinal problems, have side effects that can cause bone damage.
- Prior fracture: Breaking a bone after age 50, especially after minor trauma, is a hallmark of osteoporosis.
Certain steps can be taken to prevent some of the effects of osteoporosis including a diet rich in calcium, weight-bearing exercise, and avoidance of smoking and excessive alcohol use.
What are the treatment options for a vertebral compression fracture?
Prevention is the best form of cure. Ask your doctor about obtaining a bone mineral density test and medication options if there is a suspicion for osteoporosis and decreased bone density. Fractures can sometimes heal with time and rest. Certain pain medications can also help during the healing process. However, sometimes this conservative style of management fails to control the pain. In addition, while conservative management can relieve the pain associated with these fractures, it does not stabilize the fracture or correct the possible spinal deformity that can result from these fractures. Therefore, a minimally invasive procedure called kyphoplasty is sometimes indicated for the treatment of compression fractures when other options have not helped.
What is kyphoplasty?
Kyphoplasty is a non-surgical, minimally invasive procedure to treat the pain and discomfort associated with vertebral body compression fractures. It should be discussed with your physician when medication and other conservative treatment options fail to treat the symptoms associated with a vertebral compression fracture (VCF). The kyphoplasty procedure involves the use of a balloon to restore the vertebral body height and shape. This is followed by the injection of bone cement to strengthen the bone.
The procedure may be performed with intravenous sedation or general anesthesia, depending on the individual needs of the patient. During the procedure, the patient is lying face-down on the table. Using X-rays for guidance, the interventional radiologist inserts 2 small tubes into the center of the vertebral body. Through these tubes, balloons are placed into the vertebral body and inflated. This pushes the bone back towards its normal height and shape. It also helps create a cavity inside the vertebral body. The radiologist will then fill this space with the bone cement (called polymethyl methacrylate or PMMA). This injection will be observed with X-rays to be certain that the cement is staying within the vertebral body. Once the cement is injected, the tube is removed. The procedure takes approximately 1 hour to perform.
How will I feel after kyphoplasty?
After the procedure, you will spend time in our recovery area where specially trained nurses will monitor your condition and assess the degree to which your back pain has improved. During your hospital stay, you will be encouraged to walk and move about. Generally, you will be discharged within 24 hours and then have a one month follow-up visit with the interventional radiologist that performed the procedure. Patients are instructed to resume activity slowly during the next few days and to look for bleeding or signs of infection at the site of the procedure.
Kyphoplasty is associated with significant immediate pain reduction, stabilization of the compressed bone, and restoration of vertebral height and spinal alignment. Well over 90% of patients rate their treatment a success. Kyphoplasty has been shown to lead to a significant reduction in back pain and significant improvements in quality of life, mobility, and ability to perform the normal activities of daily living (such as walking, bending and lifting). Patients have also reported improved mental health, vitality, social function and emotional well-being.
What are the risks of kyphoplasty?
- Persistent Pain: Pain due to the procedure will typically go away within 2 weeks. Some patients, however, may complain of persistent pain after kyphoplasty. This may be due to irritation of tissues involved in the procedure itself. It is more likely due to the underlying arthritis and degeneration of the spine. If the pain is due to the arthritic degenerative changes in the spine, the usual treatment is medications and an ongoing exercise program.
- New Vertebral Body Compression Fractures: After kyphoplasty, severe osteoporosis may cause other fractures at other levels in some patients (10-15%) If more vertebrae collapse, kyphoplasty can also be used at those other levels.
- Cement Leakage: There is a small risk of the bone cement leaking from within the boundaries of the vertebral body. In most cases, this rare event does not cause any problems.
- Nerve or Spinal Cord Irritation: While very rare, the cement may irritate or damage the spinal cord or nerves. This can cause pain, altered sensation, or even paralysis (which is estimated to occur in less than 1 in 10,000 patients). Should the cement leak further, more significant surgery may be needed to stop the irritation of the nerves or spinal cord.
- Other very rare risks include the possibility of cement traveling to lungs through veins that drain blood from the vertebral body. There is an even smaller chance of the cement block becoming infected at the time of surgery or even years later. Finally, there is a rare chance that patients can react to the bone cement, resulting in an allergic reaction.
How can I find out if I am a candidate for kyphoplasty?
Kyphoplasty is generally considered a treatment option for most patients with significant back pain and deformity resulting from compression fractures due to osteoporosis or other diseases such as multiple myeloma, lymphoma, kidney disease, and cancer.
The first step towards finding out if you are a candidate for kyphoplasty is to arrange a consultation with one of our interventional radiologists. During this appointment, we will have a discussion with you about the pain you are experiencing and work with you to determine if this pain is related to a vertebral compression fracture (VCF) that can be treated with kyphoplasty.
Diagnostic studies such as x-rays, an MRI, and a nuclear medicine bone scan are often required to help us make that determination. We will also need to determine the timing of the fracture since most physicians agree that the earlier a fracture is treated, the better the outcome will be. Once a compression fracture is healed, there are no real benefits to performing kyphoplasty.
Most VCFs demonstrate advanced healing within three months after the onset of pain. Patients with compression fractures that are not healed by more than six weeks after injury have a 90% chance at good pain relief with a kyphoplasty. As a general rule, the earlier kyphoplasty is performed, the better are the chances of achieving significant correction of spinal alignment.
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