Vertebral compression fractures (VCFs)
Spinal compression fractures are a common problem, particularly in elderly patients with osteoporosis and also in those with certain types of cancer. These fractures are extremely painful, often severely limiting a patient’s mobility, and are associated with other problems such as difficulty breathing, loss of appetite, and abdominal pain.
The major goals in treatment of spinal compression fractures are stabilizing the broken bone and returning the bone as closely as possible to its normal structure. In the past, there were very few treatment options for patients suffering from spinal compression fractures. Most patients with treated with back braces, bed rest, pain medications, and physical therapy. However, back braces are uncomfortable and prolonged bed rest actually increases osteoporosis. Fracture healing often takes many months in patients with osteoporosis. Unfortunately, traditional surgical procedures for spinal fixation and stabilization do not work well in patients with osteoporosis as the screws and plates do not hold well in the brittle, weakened bones.
A vertebral compression fracture (VCF) occurs when one of the bones of the spinal column weakens and collapses. Vertebral compression fractures tend to be painful and if left untreated can adversely affect overall health and well-being.
In cases of multiple VCFs, the spine shortens and angles forward, resulting in kyphosis, or a “hunchbacked” posture. Over time, this condition may compress the lungs and abdomen, causing medical complications seemingly unrelated to the spine, such as:
- Reduced activity and alteration in mobility
- Decreased appetite and sleep disorders
- Impaired pulmonary function (breathing problems)
- Increased risk for future fracture
- Decreased quality of life; feelings of isolation and sadness
- A 23% increase in mortality rate in women over age 65 with history of prior VCF
It is important that VCFs are diagnosed and treated by a physician. A physical exam, along with an x-ray, can help determine if a compression fracture has occurred.
Fortunately, there is a new treatment option for these patients with spinal compression fractures. This procedure is called kyphoplasty. Kyphoplasty is a minimally-invasive outpatient procedure that is performed in the hospital using local anesthetic and conscious sedation (meaning that the patient is awake and comfortable during the procedure, but does not feel the procedure taking place).
Kyphoplasty is performed through two small incisions, each about the size of a pencil eraser. It stabilizes the bone fracture and often results in the compressed (flattened) vertebra to be restored to virtually its normal size and shape. Balloon catheters are inflated in the broken bone to re-expand the fracture; thick “putty-like” bone cement is then placed in the bone to “freeze” it and prevent it from breaking again.
Kyphoplasty offers fast pain relief and little recovery time with patients returning to normal activities the next day. In addition, by restoring the structure of the broken vertebra, long term health problems such as a decrease in a patient’s height, a decrease in the ability to breathe normally, and an increase in the risk of future falls may be prevented.
Most unhealed spinal compression fractures are able to be treated with kyphoplasty. Preliminary MRI or bone scan is performed to determine whether a patient is a candidate for the procedure. Results from many studies have shown a 95-98% success rate in relieving pain in these patients.
Learn more about balloon kyphoplasty
Severe lower back pain can also be from a fractured sacrum (tailbone). This is a fairly common problem in elderly patients with osteoporosis. Until now, bed rest and steroid injections were the only treatment. Now, we perform sacroplasty.
This procedure involves injecting liquid bone cement into the fractured bone to “spot-weld” the fractures. Sacroplasty is also done as an outpatient procedure using local anesthetic and conscious sedation. It has a 95% success rate at relieving pain from tailbone fractures.