What Can You Tell Me About Surgery for Vertebral Fractures?

Celeste Robb-Nicholson, M.D.

Q. I have osteoporosis and a recent spine fracture. I hear there's a minor surgical procedure that can fix the fracture. Can you tell me anything about it?

A. Fractures of the bones in the spinal column (vertebrae) are common in people with osteoporosis; about 750,000 occur each year in the United States. In this type of fracture, called a compression fracture, the vertebra collapses, often causing pain, a gradual loss of height, or stooped posture. Even if the fracture doesn't cause obvious symptoms, having one fracture increases the risk of having another one. The cumulative effect of multiple fractures is chronic pain, disability, depression, and difficulty managing normal daily activities.

Since the 1990s, two similar minimally invasive procedures -- vertebroplasty and kyphoplasty -- have been available for the treatment of compression-fracture pain that doesn't respond to more conservative measures. In both procedures, a special cement is injected into the compressed vertebra to stabilize it.

In vertebroplasty, the cement is introduced via a hollow needle inserted through a small incision in the skin. In kyphoplasty, tiny inflatable balloons are inserted into both sides of the vertebra before cement is injected. When the balloons are inflated, they create a small cavity in the bone and help restore vertebral height. The balloons are then deflated and withdrawn, and the cavity is filled with cement.

In experienced hands, both procedures are generally quite safe. The main worry is that cement can leak into places where it could cause serious problems, such as the spinal canal or the bloodstream. But these complications are extremely rare in the treatment of osteoporosis-related vertebral fractures. The long-term effects of cement in a vertebra are unknown.

Various studies have indicated that these procedures reduce pain and improve function in patients with spinal compression fractures, but when we last wrote on the subject, there were no randomized, placebo-controlled trials. Since then, in two such trials, vertebroplasty has been found to be no more effective than a sham treatment in which surgeons simulated the procedure but didn't inject any cement. There are no placebo-controlled trials evaluating kyphoplasty.

Further studies are underway, including some that will compare vertebroplasty with kyphoplasty. In the meantime, some experts are urging caution. Guidelines issued in September 2010 by the Academy of Orthopaedic Surgeons recommended against the use of vertebroplasty for treating spinal compression fractures due to osteoporosis. The Academy called kyphoplasty an "option," giving it only a weak recommendation because the studies indicating that it is more effective than vertebroplasty or conservative treatment have been flawed or inconsistent.

For now, I suggest that you avoid both of these procedures and concentrate on more conservative measures. Early on, many people need bed rest for a while, but you should resume some activity as soon as possible to avoid further bone loss. To relieve pain, try over-the-counter analgesics, such as acetaminophen or nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen). Ice or heat packs may also help.

Talk to your doctor about calcitonin nasal spray (Fortical, Miacalcin), which can boost the effect of analgesics. Back braces can help manage pain and stabilize the spine while the fracture heals.

Once your pain has improved, it's important that you do all you can to strengthen your bones and reduce the risk of another vertebral fracture. That includes getting regular weight-bearing exercise, such as walking, and taking 1,200 milligrams of calcium and 1,000 international units of vitamin D daily.

You might also consider bisphosphonate drugs, which can improve bone mineral density and reduce the rate of new vertebral fractures by as much as 50 percent.-- Celeste Robb-Nicholson, M.D., Editor in Chief, Harvard Women's Health Watch

Vertebral Fractures

A vertebral fracture is a break in one or more of the bones of the spine (vertebrae). It can result from trauma, osteoporosis, or other underlying conditions that weaken the bones. Vertebral fractures can cause pain, loss of height, and spinal instability. Treatment options may include pain management, immobilization, and surgery, depending on the severity and location of the fracture.

Vertebral fracture surgery is a procedure performed to treat a broken vertebra, with the goal of relieving pain, restoring stability to the spinal column, and preserving the spinal alignment. The type of surgery performed will depend on the type and location of the fracture, as well as the patient's overall health. Some common surgical options include:

Vertebroplasty

A minimally invasive procedure in which cement is injected into the damaged vertebral body to stabilize it.

Kyphoplasty

Similar to vertebroplasty, but with a balloon is first inserted into the vertebral body to create a cavity, followed by injection of the cement.

Spinal Fusion

A procedure in which two or more vertebral bodies are joined together to create a single, solid unit.

Spinal Decompression

A procedure in which part of a vertebral body is removed to relieve pressure on the spinal cord or nerves.

Instrumented Fusion

A procedure that involves the use of metal rods, screws, and plates to stabilize the spine and promote fusion of the vertebral bodies.

These surgical procedures can be performed using open or minimally invasive techniques, and the choice of surgical approach will depend on the individual patient's needs and the surgeon's preference and expertise.

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