A New Treatment Option for Refractory Vertebral Compression Fractures


A New Treatment Option for Refractory Vertebral Compression Fractures

Vertebral compression fracture [VCF] is the most common complication of osteoporosis. Over 750,000 compression fractures are recorded per year at an average yearly cost of 750 million dollars. Fortunately, most compression fractures are benign. The acute pain of the fracture resolves with medical management; a few days of bed rest, Calcitonin and pain medications allow most patients to return to their activities of daily living.

A finite number of patients, however, are left with long term sequelae from their VCF. The kyphotic deformity [i.e., stooped over position] commonly seen with multiple thoracic VCF can lead to chronic thoracic and low back pain. The abnormal kyphoses increases the work load of the paraspinal muscles which leads to chronic pain and fatigue.

Furthermore, deformity causes compression of the viscera; this compression results in early satiety and weight loss in this population. The lung’s functional capacity is also significantly reduced; each VCF causes a 9% loss of forced vital capacity. Patients with multiple VCFs are at significantly increased risk of pneumonia as well.

Finally, multiple studies have confirmed the increased mortality risk associated with VCF. When compared to controls, patients with VCF had a 5 year survival of 61% compared to 76% for their matched peers. A study of 9,575 women followed for over 8 years demonstrated a 23% increased mortality rate compared to patient without VCF [Figure 2].

With the recent advances in spinal surgery, it is not surprising that a viable, minimally-invasive option is now available to help patients with refractory VCF. The ideal treatment for a VCF would be to stabilize the fracture while correcting the deformity. Previously, surgical intervention was only indicated in cases with pending or present neurological compromise.

A new technique of percutaneous stabilization of vertebral fractures [Kyphoplasty], however, allows for restoration of the vertebral body height with injection of cement to stabilize VCFs. The patient is placed in a prone position. Using fluoroscopy, the surgeon introduces a cannula into the vertebral body through the pedicle posteriorly. A balloon is subsequently utilized to inflate and “jack up†the vertebrae to its normal, non compressed height. Subsequently, cement is injected into the void to prevent future collapse. [Figures 1 and 3].

The procedure is fairly quick [about 45 minutes per level] and is tolerated very well by the patients. Most patients wake up in recovery room with their back pain significantly improved. Often, they are able to leave the hospital on the first postoperative day with no further need for medical attention.

In Summary:

· Most vertebral compression fractures resolve with medical management;
· Kyphoplasty is a minimally-invasive procedure to help patients with refractory compression fractures;
· Patients who fail at least 2 weeks of conservative management are good candidates for Kyphoplasty;
· 90% of patients have significant pain improvement with the procedure which is fairly quick and well tolerated with overnight hospital stay.

Compression fracture image

Figure 1: The common pathway for worsening symptoms with compression fractures.

Kyphoplasty image

Figure 2 and 3: With Kyphoplasty, a tube is introduced into the broken vertebrae which can be lifted back to its pre-fracture shape.

lumbar xrays showing fracture for kyphoplasty

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