Spinal fracture fundamentals
Even minor falls or trauma can produce a spine fracture. Many of these injuries will never require surgery, but major fractures can result in serious long-term problems unless treated promptly and properly. Spine fractures range from painful compression fractures, often seen after minor trauma in osteoporotic patients, to more severe injuries such as burst fractures and fracture-dislocations that occur following auto accidents or falls from height. These severe injuries frequently result in spinal instability, with a high risk of spinal cord injury and pain.
Osteoporosis, or weakening of the bones, can lead to painful vertebral compression fractures. Until recently the only treatment was bracing and narcotic medications which frequently lead to ongoing pain and progressive deformity. The spinal surgeons at Cleveland Clinic Center for Spine Health can now, using a new technology, re-expand the vertebral body (kyphoplasty) and augment its strength by injecting bone cement. This can be done as an outpatient in a minimally invasive fashion. In other cases cement injection without re-expansion of the fracture (vertebroplasty) can be performed.
What causes the fracture?
When an external force is applied to the spine, such as from a fall, the forces may exceed the ability of the bone within the vertebral column to support the load. This may cause the front part of the vertebral body to crush, resulting in a compression fracture. If the entire vertebral column breaks, it results in a burst fracture.
If the compression is mild, you will experience only mild pain and minimal deformity. If the compression is severe, affecting the spinal cord or nerve roots, you will experience severe pain and a hunched forward deformity (kyphosis).
Osteoporosis is the most common risk factor for fractures, as the disease causes bones to weaken.
What are my treatment options?
Most fractures are treated with immobilization in a brace or corset for up to 12 weeks. Bracing helps to reduce pain and prevent deformity.
Severe cases may require surgery.
Vertebroplasty is a new surgical procedure that may be used to treat compression fractures. In this procedure, the surgeon inserts a catheter into the compressed vertebra. The catheter is used to inject the fractured vertebrae with bone cement, which hardens, stabilizing the vertebral column. This procedure has been shown to reduce or eliminate fracture pain, enabling a rapid return to mobility and preventing bone loss due to bed rest. However, it does not correct the spinal deformity.
Kyphoplasty involves inserting a tube into the vertebral column under X-ray guidance, followed by the insertion of an inflatable bone tamp. A tiny incision is made in the back. Once inflated, the tamp restores the vertebral body back toward its original height, while creating a cavity to be filled with bone cement. The cement seals off cracks and cavities, and prevents the vertebra from re-collapsing. After the cavity is filled, the tube is removed and the incision stitched. Since August 1998, hundreds patients have been treated at The Cleveland Clinic with kyphoplasty.
Stabilization can also be achieved by removing broken vertebra and replacing them with a plate, screws, or cage.
What are the risks of surgery? Is the surgery safe?
Risks of surgery include nerve injury, infection, bleeding, and stiffness.
How do I prepare for surgery?
Quit smoking if you smoke, exercise on a regular basis to improve your recovery rate, stop taking any non-essential medications and any herbal remedies which may react with anesthetics or other medications and ask your surgeon all the questions you may have.
What happens after surgery?
Generally, an overnight hospital stay is not required for kyphoplasty, unless you have other serious health problems, such as hypertension or a heart condition.
How long is the recovery period after surgery?
Typically, braces are worn for six to 12 weeks after surgery in addition to three to six weeks of physical therapy.
After kyphoplasty, patients are encouraged to resume normal activities as soon as possible, without any restrictions. Your doctor may recommend physical therapy and rehabilitation.
What are the CCF physician credentials?
- All doctors at Cleveland Clinic Center for Spine Health are fellowship-trained and board-certified or board-eligible in orthopaedic surgery, medical spine or neurosurgery. In addition, our surgeons have subspecialty training and years of experience in spine surgery.
- All Cleveland Clinic staff radiologists are board-certified or board-eligible in radiology or have the international equivalent.
- All Cleveland Clinic staff rehabilitation specialists are board-certified or board-eligible in physical medicine and rehabilitation, or have the international equivalent.
- All Cleveland Clinic staff pain management specialists are board-certified or board-eligible in pain management or have the international equivalent.
How do I make an appointment?
Call 216.444.BACK (2225) or toll free 800.223.2273, ext. 42225, Monday through Friday, 8:00 a.m. to 5:00 p.m. (Eastern Standard Time).
What clinical trials are being conducted at CCF on the procedure?
Researchers at the Cleveland Clinic are involved in ongoing studies that investigate new drugs and treatment approaches for managing disease. Participants in these clinical trials can play a more active role in their own health care, gain access to new research treatments before they are widely available, and help others by contributing to medical research. There are currently more than 1,700 active clinical studies underway.
Are there other resources that I can go to for more information on the procedure?
Patients can go to the following resources for more information on this procedure:
- Cleveland Clinic Health Information Center
- American Academy of Orthopaedic Surgeons
- North American Spine Society
- Spine Universe Website
Why should I seek a second opinion regarding treatment for this procedure?
As modern medical care grows more complex, patients can feel overwhelmed. The opportunity to consult a recognized authority about a particular diagnosis and treatment can bring peace of mind at an emotionally difficult time. A second opinion may be beneficial when:
- You are uncertain about having surgery.
- You still have questions or concerns about your current treatment.
- A controversial or experimental treatment is recommended.
- You have multiple medical problems.
- You have choices to make about treatment.
A convenient way to obtain a second opinion is e-Cleveland Clinic, a contemporary adaptation of The Cleveland Clinic’s 80-year tradition as a nationally designated referral center. An easy-to-use, secure, from-home second opinion service, e-Cleveland Clinic utilizes sophisticated Internet technology to make the skills of some of our specialists available to patients and their physicians, anytime, anywhere. With e-Cleveland Clinic’s personalized access, no patient need ever to feel unsure or uninformed when faced with what could potentially be one of the most important decisions of their life. Learn more about e-Cleveland Clinic.