Vertebroplasty Can Ease Pain of Compression Fractures

As the population of the US ages, compression fractures of the spine due to osteoporosis are becoming more common. According to the US Centers for Disease Control and Prevention (CDC), an estimated 10 million Americans already have osteoporosis and another 34 million are at risk for developing the condition. Osteoporosis is responsible for more than 1.5 million fractures annually, including 700,000 spinal fractures. Minor trauma such as falling at home or even sneezing can sometimes cause spinal fractures; often the patient doesn't realize a bone has fractured until back pain develops.

In addition to the so-called "dowager's hump" on the back and the loss of height we associate with compression fractures, there are additional health issues involved. Chest capacity diminishes and the abdomen protrudes; these changes can affect respiratory and gastrointestinal function. Self-esteem and body image can also be affected, and individuals often become more apprehensive of any activity that might result in injury.

"Bone Cement" Can Stabilize Fractures
For those who do suffer one or more vertebral fractures, treatment can involve bed rest, medication, or a brace to support the spine. These measures are sufficient for pain relief in the majority of fracture patients. But in those patients for whom these treatments are not effective, a procedure called vertebroplasty, in which a "bone cement" called methylmethacrylate is injected into the fractured vertebrae, could help alleviate their pain.

Raj Rao, MD, is an Associate Professor of Orthopaedic Surgery and Director of Spine Surgery in the Department of Orthopaedic Surgery at the Medical College of Wisconsin. He specializes in the surgical and non-surgical treatment of spinal disorders of the neck and back, and explains how vertebroplasty works. "We first use X-rays and Magnetic Resonance Imaging (MRI) to find out if the patient has a fracture. We then try to determine whether the fracture is old or new, and rule out other conditions. Not all back pain, even in the elderly, is from a fracture. It could be from arthritis, disc problems, pinched nerves, or even rib fractures."

The vertebroplasty procedure itself takes about an hour. "The procedure is more comfortable for the patient under general anesthesia," says Dr. Rao. "We locate a safe path entering the vertebral body, and inject the cement into the vertebrae. This splints the fracture internally, and provides pain relief." The pain from the fracture should be relieved within just a few days, says Dr. Rao.

A similar procedure, kyphoplasty, is used in compression fractures as well. It is similar to vertebroplasty, except that a balloon is first inserted into the vertebrae to increase the space within the vertebrae. The cement is then injected into the void left behind after the balloon is withdrawn.

Best Used for New Fractures
Although both vertebroplasty and kyphoplasty are relatively simple procedures, Dr. Rao advises caution regarding their use. "Vertebroplasty and kyphoplasty are an option when other treatments do not work. The procedures work best for a new fracture - preferably a single-level fracture - with pain directly over the fracture site." They are not for arthritis or other vertebral pain, or for fractures in young individuals sustained in an injury such as a car crash, Dr. Rao notes, but strictly for fragility or compression fractures in the elderly.

Dr. Rao does not recommend vertebroplasty or kyphoplasty be carried out to prevent fractures from developing in thin bone. "We don't know whether the patient with weak vertebrae will ever develop a fracture," says Dr. Rao, "and we still don't know the long-term effects of the procedure." Side effects from the procedures are possible, such as minor leakage of the cement into the surrounding areas. "Depending upon how the cracks in the fractured bone are arranged and how thin the bone is, the injected bone cement could spread to the surrounding muscles, disc or nerves," Dr. Rao says. Although the leakage does not usually cause adverse effects, it should be carefully monitored during the procedure.

Because of the advanced age of most patients who undergo vertebroplasty and kyphoplasty, anesthesia can also be an issue. "In some cases the substantial risks of general anesthesia in an elderly patient may make it safer to carry out the procedure using local anesthesia," says Dr. Rao.

Prevention is always preferable to treatment, and Dr. Rao says there are measures people can take to prevent a fracture. "Appropriate nutrition is essential, especially getting enough vitamin D and calcium during the earlier years, and not abusing tobacco or alcohol. Bone density testing, and treatment if needed, is important for anyone at risk for developing osteoporosis. Also, a general routine of activity and stretching, even yoga or Tai Chi if possible, will help prevent falls and maintain balance."

If you think you might be at risk for osteoporosis and the possibility of a compression or fragility fracture, your family physician can help with an individualized prevention program to help you maintain your bone health.

P. J. Early
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.