Treatment Options for Spinal Compression Fractures

Minimally invasive surgical procedures can be used to treat spinal compression fractures. These procedures reduce severe pain, stabilize the fracture itself, and restore the lost height or shape of the broken vertebral body. These procedures are known as:

• Balloon kyphoplasty
• Vertebroplasty
• Vertebral body augmentation

A vertebral compression fracture is a type of spinal fracture caused by osteoporosis. This metabolic disease weakens bone density and increases the risk of fracture/s in the spine, wrist, and hip. Osteopenia and osteoporosis affect millions, according to the National Osteoporosis Foundation. If left untreated, it can progress without an individual knowing and painlessly until the bone/s fracture. A vertebral compression fracture is more frequent than hip fractures and can lead to extended disability.

Vertebroplasty

Vertebroplasty is a minimally invasive treatment done through the skin for painful vertebral compression fractures. It also helps strengthen the surrounding vertebral bodies at risk of fracturing. Orthopedic bone cement is injected into the fractured vertebral body.

How is it performed?

Under general anesthesia, a specialized needle for bone is slowly inserted through the soft tissues of the back towards the vertebral compression fracture. The surgeon sees the position of the needle at all times through a real-time x-ray. Once reached, a small amount of orthopedic bone cement, polymethylmethacrylate, is injected into the vertebral body. Polymethylmethacrylate is a medical-grade bone cement used for years for various orthopedic procedures.

The cement can sometimes be combined with an antibiotic to reduce the risk of infection and a powder with barium or tantalum. This allows it to be seen on the x-ray. The cement is a thick paste that hardens quickly. The fractured body is injected on the right and left sides, the midline of the back. After a few hours, the patient is up and moving. Most go home on the same day.

Balloon kyphoplasty

Balloon Kyphoplasty is another newer minimally invasive surgery for vertebral compression fractures that can be associated with osteoporosis. Kyphoplasty utilizes a balloon that expands the compressed bone to help restore lost vertebral height while creating a space where bone cement is injected. Kyphoplasty stabilizes fractures, restores lost vertebral height, and reduces deformities.

How it is performed?

Balloon kyphoplasty is performed under local or general anesthesia. Using real-time x-ray, two small incisions are made, and a probe is inserted into the vertebral body. The bone is drilled and balloon/s, called a bone tamp, a pump inserted on each side.

These balloons are inflated with contrast medium, so the surgeon can see on the real-time x-ray until each balloon expands to the correct height, and then are taken out. The balloon creates a space for the bone cement and helps expand the compressed vertebral body bone. The cement binds and stabilizes the fracture. The cement provides:

• Strength
• Stability
• Hardens rapidly
• Restores height
• Relieves pain

Vertebral augmentation implant

A vertebral augmentation implant is different from vertebroplasty and kyphoplasty. This minimally invasive procedure for middle and lower back spinal compression fractures utilizes a flexible loop spring-style spinal implant. It is performed under local or general anesthesia. A real-time x-ray is used to visualize the spinal anatomy and guide the placement of the device. The implant is delivered through a small incision. Once the implant is in place, the bone cement is injected, and the implant is removed.

Potential benefits include:

• Reduction of new fractures above or below the existing fracture
• Improves the spine’s angle
• Reduced spinal deformity
• Reduces bone cement leakage
• Reduces the amount of bone cement

Benefits of all

Vertebral compression fractures and the limited abilities of traditional surgical options led to the refinement of these surgical systems. Each procedure provides options for how the treatment helps relieve pain, reduce and stabilize fractures, reduce spinal deformity, and stop the progressive worsening of untreated osteoporosis.

Added benefits:

• Surgical time is minimal
• Local or general anesthesia is all that is needed
• Hospital stay is a day or only a few hours
• Patients can quickly return to normal activities
• No bracing required

A spine surgeon will explain the purpose and aims of the recommended procedure, including the benefits and risks, to help make an informed decision.

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