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Diseases & Conditions

Surgical Treatment of Vertebral Compression Fractures

Osteoporosis is a common bone disease characterized by the progressive loss of bone density (strength). The loss of bone density is typically caused by a loss of calcium and other minerals found in the bones. Low bone mass and structural deterioration of bony tissue can lead to fractures (breaks). Especially common are fractures of the hip, spine, and wrist, although there is the potential that any bones can be affected. These fractures can lead to loss of height, stooped posture, humpback (kyphosis), and severe, debilitating pain.

Statistics

Though osteoporosis occurs in both men and women, women are four times more likely to develop the disease than men. After age 50, one in two white women and one in four white men will have an osteoporosis-related fracture in their lifetimes. Ten percent of African American women over age 50 have osteoporosis. An additional 30 percent have low bone density that puts them at risk of developing osteoporosis. Osteoporosis is responsible for more than 1.5 million fractures each year.

Risk factors

  • Controllable risk factors include: Low calcium diet, high caffeine use, smoking, excessive alcohol consumption, chronic dieting, estrogen deficiency, sedentary lifestyle.
  • Uncontrollable risk factors include: Caucasian or Asian background, thin or petite body frame, family history of osteoporosis, early menopause, lactose intolerance.

Vertebral Compression Fractures

Vertebral compression fractures usually have a sudden onset. Such fractures are painful and it can take several months for the pain to improve. In severe osteoporosis, the vertebrae become so weak they collapse upon themselves, leading to spinal deformity.

Symptoms

  • As vertebral bones collapse, the loss of vertebral height actually causes the patient to lose height.
  • Physical deformities often develop such as a "humpback" or kyphosis, which causes severe pain, tingling, numbness, and weakness.
  • As the structure changes, the upper body height can be lost allowing the ribs to drop towards the hips. This causes breathing difficulty and can also lead to compression of internal organs, causing the abdomen to protrude (stick out).
  • Symptoms can be damaging to a patient’s quality of life.
  • Vertebral fractures may initially be felt or seen in the form of low back pain, loss of height, or spinal deformities such as kyphosis.

Diagnosis

Once a vertebral fracture occurs, it is usually diagnosed with x-ray films. Painless and accurate medical tests can provide you with information about your bone health before problems begin. Bone Mineral Density tests (BMD tests), or bone measurements, also known as Dual X-ray Absorptiometry (DXA) scans, are x-rays that use very small amounts of radiation to determine the bone density of the spine, hip, or wrist. Your physician can order these tests for you. All women over the age of 65 should have a bone density test. The DXA scan is done earlier for women with risk factors for osteoporosis. Men over age 70, or younger men with risk factors, should also consider getting a bone density test.

Treatment

Goals of treatment are to reduce bone loss, prevent fracture, control pain, and prevent disability.

  • Conservative Medical Management:
    • Estrogen therapy, Evista, Fosamax, Boniva, Actonel, Atelvia, Prolia, Reclast and Forteo all help to control bone loss
    • Miacalcin nasal spray may help to control pain from vertebral fractures. However, because it has a very weak effect at controlling further bone loss, it is very rarely used
    • Pain management options include anti-inflammatories, narcotics, pain relievers, injections and physical therapy
  • Surgical Management:
    • Kyphoplasty:
      • Newer procedure
      • Involves placing a catheter with a balloon into a collapsed vertebral body and slowly inflating the balloon to help the fracture and restore height
      • Special surgical cement is injected into the cavity created by the balloon once it has been deflated
      • The goal is to prevent worsening of the fracture and restore vertebral body height
      • Lesser risk of leakage of the surgical cement when compared to vertebroplasty
    • Vertebroplasty:
      • Similar to kyphoplasty, however no balloon is used
      • A cement mixture of polymethylmethacrylate is injected into the vertebral body to lend support and stabilize the fractured spine
      • Goal is to reduce or eliminate fracture pain, but does not address spinal deformity
    • Major Anterior/Posterior Reconstruction/Fusion
      • Major procedure with higher risks in the elderly patient
      • Difficult to do surgery on weak bones that are fragile

Recent studies in the New England Journal of Medicine and Lancet have given conflicting results about the effectiveness of vertebroplasty and kyphoplasty.  This probably shows the importance of appropriate patient selection for these procedures. In appropriately selected patients both kyphoplasty and vertebroplasty might offer benefit with lesser surgical risk.

Prevention

Preventing osteoporosis is key to preventing vertebral compression fractures.
Effort should begin early with eating a consistently well-balanced diet that is rich in many vitamins and minerals. Detailed patient education handouts on getting the right amount of calcium and vitamin D are available. Please ask your doctor for these. Daily exercise is important. Making healthy life-style choices such as avoiding tobacco or excessive alcohol also is important. Medications can be used to treat patients who have already been diagnosed with osteoporosis or osteopenia (weaker bones, but not as severe as osteoporosis).

References:

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 10/1/2012...#9954

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