Treatment Options for Vertebral Compression Fractures

What are the Symptoms of Vertebral Compression Fractures?
Pain varies from person to person, depending on the location and severity of the fracture, as well as the individual’s overall health. For some people, the pain is minimal and subsides as the bone heals (usually over a period of two to three months). For others, the pain may continue even after the fracture has healed.

Unlike with a broken wrist or hip, you may not know that you have suffered a VCF. Symptoms that may indicate a VCF include sudden, severe back pain; worsening pain when walking or standing, difficulty and increased pain when bending and twisting; a curved or stooped posture; and experiencing some relief from pain when lying down. For an accurate diagnosis, an x-ray or another form of imaging is needed.

Having one VCF is a major risk factor for incurring another one. Multiple vertebral compression fractures can lead to spinal deformity and can make normal activities painful and difficult.

What are the Treatment Options for Vertebral Compression Fractures?
Conservative treatments for VCFs include bed rest, oral pain medications, steroid or pain relieving injections, back braces, physical therapy, and anti-inflammatory drugs. For many, this is not enough to alleviate the pain from a VCF. In the past, any additional treatment required open back spinal surgery. Today however, those who do not respond to non-operative treatments and are faced with severe pain and/or disability can also consider two types of minimally invasive spine surgery to treat vertebral compression fractures. These are vertebroplasty and kyphoplasty.

Percutaneous vertebroplasty was developed in France in the 1980s, and has been performed in the United States for nearly twenty years. This minimally invasive procedure is designed to relieve the pain caused by vertebral compression fractures, and to strengthen weakened vertebral bodies in the hopes of preventing future fractures. In this procedure, a small amount of medical grade acrylic cement called polymethylmethacrylate (PMMA) is injected into the collapsed vertebra to stabilize and strengthen the fracture and vertebral body. Using a flexible needle, the surgeon is able to directly access the entire vertebra through one small incision and precisely deliver the bone cement. When the cement is injected it is a viscous paste, but it hardens rapidly. Most percutaneous vertebroplasty patients are ambulatory within a few hours after the procedure. Patients often experience significant improvement from their fracture symptoms within six to twelve weeks, and can return to their normal activities once the fracture has fully healed.

Percutaneous Vertebral Augmentation, or kyhphoplasty, is a newer treatment option which is also a percutaneous and minimally invasive procedure. In kyphoplasty, a device is used to create a space within the vertebral body which is then filled with bone cement to strengthen the vertebra. Kyphoplasty is performed under local or general anesthesia. Using image guidance x-rays, a small incision is made, and a device is inserted into the center of the vertebral body to the site of the fractured bone. The space created by the device is then filled with PMMA, the same orthopedic cement used in vertebroplasty, to seal up the fracture. As in vertebroplasty, the cement hardens quickly, providing strength and stability to the vertebra.

Procedures such as vertebroplasty and kyphoplasty can provide substantial benefits, including pain relief, stabilization of bone fractures, and a reduction of the debilitating effects of progressive osteoporosis. Compared to traditional surgical procedures, these minimally invasive procedures generally require a much smaller incision, can be performed on an outpatient basis, and allow patients to enjoy a quicker return to normal activity. Though no surgery can have a guaranteed outcome, these new treatments provide more options for people who have suffered a vertebral compression fracture.