What is a vertebral compression fracture?

Vertebral bodies are the round bones in your back that are stacked on each other, form what we know as the spine.  Between each bone is a soft tissue cushion called the intervertebral discs.  The pressure on each bone is enormous with all of the activities we perform throughout life.  Many factors may begin weakening these bones such as osteoporosis, trauma, or cancer.  Once they become weakened, they can begin to collapse or compress down.  This is known as a compression fracture.  Since there are many nerves surrounding the bones, the fracture can cause significant pain and decreased ability to move.  In the past, patients were advised to simply stay in bed until the bone heals itself.  However, the pain often never completely resolved.

How can vertebroplasty and kyphoplasty procedures treat these fractures?

Vertebroplasty, a nonsurgical treatment performed by our interventional radiologists using imaging guidance, stabilizes the collapsed vertebra with the injection of medical-grade bone cement into the spine. This reduces pain and can prevent further collapse of the vertebral body.  A similar procedure called kyphoplasty involves first expanding the bone before injecting cement.  This can help regain some height of the vertebral body.  Both procedures dramatically improves back pain within hours of being completed, provide long-term pain relief, and have near zero complication rates. 

If the vertebral body isn't repaired by this procedure, it can heal in a compressed or flattened wedge shape. Once this occurs, the compression fracture cannot be treated effectively.  Thus,  is very important for someone with persistent spinal pain lasting more than a few weeks to consult our Center, and people who require constant pain relief with narcotics should seek help immediately.

What is the history of this procedure and does it really work?

Vertebroplasty was first performed in France in 1984 to treat compression fractures caused by bone cancer or bone metastasis, and later to treat compression fractures caused by osteoporosis.  Percutaneous vertebroplasty was introduced in the United States in 1994 and has become widely available since 1997 as a treatment for pain associated with compression fractures due to osteoporosis.  The procedure has been shown to provide continued pain relief for osteoporotic compression fractures.  A 1998 study by Dr. Deramond and colleagues reported on 80 patients with rapid and complete pain relief in more than 90 percent of osteoporotic cases.  The follow-up in this patient population ranged from one month to 10 years with evidence of prolonged pain relief.  Vertebroplasty and kyphoplasty are the standard of care for treating painful, osteoporotic compression fractures.

How is the procedure performed?

Vertebroplasty and kyphoplasty procedures are outpatient treatments which use X-ray imaging and conscious sedation.  Dr. Dunfee or Dr. Kennedy will insert a needle through a tiny nick in the skin on your back at the level of your compression fracture.  Using fluoroscopy or continuous, low-dose X-ray, the needle will be directed under fluoroscopy into the fractured vertebral body.  Medical-grade bone cement will then be injected into the bone.  If a tumor is the cause of the fracture, a radiofrequency ablation needle may first be inserted to "burn' the tumor away.  The entire procedure takes takes less than one hour to perform, depending on how many bones are treated. The cement hardens within 15 minutes and stabilizes the fracture, like an internal cast. 


How long does it take to recover after a vertebroplasty or kyphoplasty procedure?

Some patients experience immediate pain relief after the procedure-- even in the recovery area!  Most report that their pain is gone or significantly better within 48 hours and begin to resume their previous daily activities.


What makes me at risk for osteoporosis and vertebral compression fractures? 

• Female
  
• Older age/ Post menopausal
  
• Family history of osteoporosis
  
• Being thin or having a small frame
• Low calcium in diet
• Long-term use of medications like steroids
• Low physical activity
• Tobacco or excessive alcohol use
• Anorexia/ bulimia