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Compression fractures occur in more than 700,000 patients per year in the United
States, are more frequent than hip fractures, and often result in prolonged disability.
Until recently, doctors were limited in how they could treat osteoporosis-related spine
fractures. Pain medications, bed rest, bracing or invasive spinal surgery were the only
options available. Today there are two promising therapeutic and preventive treatments for
compression fractures. They are called vertebroplasty and kyphoplasty.
Treatment of Compression fractures - Vertebroplasty
Vertebroplasty was originally developed in France in 1986 and has been further refined
and available in the United States since 1991.
Vertebroplasty is a minimally invasive, non-surgical procedure that is designed to
relieve the pain of compression fractures. Vertebroplasty literally means fixing the
vertebral body. In addition to relieving pain, those vertebral bodies that are weakened
but not yet fractured can be strengthened, thus preventing future problems.
Treatment of Compression fractures - How is Vertebroplasty performed
Under general anesthesia, a special bone needle is passed slowly through the soft
tissues of the back. Image guided x-ray, along with a small amount of x-ray dye, allows
the position of the needle to be seen at all times. A small amount of orthopedic cement,
called polymethylmethacrylate (PMMA), is pushed through the needle into the vertebral
body. PMMA is a medical grade substance that has been used for many years in a variety of
orthopedic procedures. The cement is mixed with an antibiotic to reduce the risk of
infection, and a powder containing barium or tantalum, which allows it to be seen on the
X-ray. When the cement is injected it is like a thick paste, but hardens rapidly. Usually
each vertebral body is injected on both the right and left sides, just off the midline of
the back.
Within a few hours, patients are up and moving around. Most go home the same day.
Treatment of Compression fractures - Kyphoplasty
Kyphoplasty is another promising treatment for patients immobilized by the painful
vertebral body compression fractures associated with osteoporosis. Like vertebroplasty,
kyphoplasty is a minimally invasive procedure that can alleviate up to 90 percent of the
pain caused by compression fractures. In addition to relieving pain, kyphoplasty can also
stabilize the fracture, restore height and reduce deformity.
Treatment of Compression fractures -How is Kyphoplasty performed?
Kyphoplasty is performed under local or general anesthesia. Using image guidance
x-rays, two small incisions are made and a probe is placed into the vertebral space where
the fracture is located. The bone is drilled and a balloon, called a bone tamp, is
inserted on each side. These balloons are then inflated with contrast medium (to be seen
using image guidance x-rays) until they expand to the desired height and removed. The
spaces created by the balloons are then filled with PMMA, the same orthopedic cement used
in vertebroplasty, binding the fracture. The cement hardens quickly, providing strength
and stability to the vertebra, restoring height and relieving pain.
Treatment of Compression fractures - Benefits of Vertebroplasty and Kyphoplasty
Limitations in the traditional treatments of vertebral compression fractures have led
to the refinement of such procedures as vertebroplasty and kyphoplasty. These procedures
provide new options for compression fractures and are designed to relieve pain, reduce and
stabilize fractures, reduce spinal deformity and stop the “downward spiral” of
untreated osteoporosis.
Additional benefits of these procedures include:
- Short surgical time
- Only general or local anesthesia required
- Average hospital stay is one day (or less)
- Patients can quickly return to the normal activities of daily living
- No bracing required
Both vertebroplasty and kyphoplasty utilize a cement-like material that is injected
directly into the fractured bone. This stabilizes the fracture and provides immediate pain
relief in many cases. Kyphoplasty has the additional advantage of being able to restore
height to the spine thus reducing deformity. After either procedure, most patients quickly
return to their normal daily activities.
As yet, the FDA has not given approval to medical companys to promote vertebroplasty
and kyphoplasty. Both techniques remain “off-label” uses. However, many
physicians believe the techniques to be efficient and safe and are using them in their
practices. Research continues to be done to study the outcomes of these procedures and the
initial findings are encouraging.
While vertebroplasty and kyphoplasty are encouraging developments, it remains essential
that osteoporosis sufferers seek medical help and learn about ways to treat their
condition as well as ways to prevent future problems. |
