Surgical Treatment of Vertebral Compression Fractures
Osteoporosis is a common bone disease marked by the increasing loss of bone density (strength). 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 any bones can be affected. These fractures can lead to loss of height, stooped posture, humpback (kyphosis), and severe, debilitating pain.
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.
What are the risk factors for vertebral compression fractures?
Controllable risk factors include:
Uncontrollable risk factors include:
Vertebral compression fractures
Vertebral compression fractures usually happen suddenly. Such fractures are painful, and it can take several months for the pain to improve. In severe osteoporosis, the vertebrae become so weak that they collapse upon themselves, leading to spinal deformity.
What are the symptoms of vertebral compression fractures?
Vertebral fractures may appear as low back pain, loss of height, or spinal deformities such as kyphosis. Symptoms can be damaging to a patient’s quality of life.
As vertebral bones collapse, the loss of vertebral height actually causes the patient to lose height.
Physical defects (such as a "humpback" or kyphosis) often develop, 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 can cause breathing difficulty and compression (squeezing) of internal organs, which can make the abdomen protrude (stick out).
How are vertebral compression fractures diagnosed?
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.
How are vertebral compression fractures treated?
The 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, and Reclast all help to control bone loss. Forteo can help to rebuild lost bone.
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. Also, it has been reported to the FDA that there may be a link between Miacalcin and cancer.
Pain management options include anti-inflammatories, narcotics, other pain relievers, injections, and physical therapy.
Kyphoplasty: This is a newer procedure that 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 keep the fracture from getting worse, and to restore vertebral body height. There is a lesser risk of leakage of the surgical cement when compared to vertebroplasty.
Vertebroplasty: This procedure is similar to kyphoplasty, but no balloon is used. A cement mixture of polymethylmethacrylate is injected into the vertebral body to lend support and stabilize the fractured spine. The goal is to reduce or eliminate fracture pain, but this procedure does not address spinal deformity.
Major anterior/posterior reconstruction/fusion: This is a major procedure with higher risks in the elderly patient. It is difficult to do surgery on weak bones that are fragile.
Studies in the New England Journal of Medicine and The Lancet have given conflicting results about the effectiveness of vertebroplasty and kyphoplasty. This probably shows the importance of choosing the right patients for these procedures. In appropriately selected patients, both kyphoplasty and vertebroplasty might offer benefit with lesser surgical risk.
How can vertebral compression fractures be prevented?
Preventing osteoporosis is key to preventing vertebral compression fractures. Efforts should begin early with 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 lifestyle choices, such as avoiding tobacco or too much 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).
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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: 10/29/2015...#9954