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Compression fractures of the spine are a common and significant problem. Although they can be caused by cancer, trauma or infection, the most common cause is osteoporosis. With osteoporosis, the bone becomes weakened and the compression fractures occur after minor, sometimes unnoticed incidents. While uncomplicated compression fractures are not associated with neurological dysfunction, they tend to be quite painful and can be very debilitating.
In the past, compression fractures were treated with analgesics and bed rest. Treated this way, the pain typically persists for weeks or even months. Two relatively new procedures, vertebroplasty and kyphoplasty, are available to reduce the pain by stabilizing the fracture.
How is the procedure performed?
Vertebroplasty is performed by placing a large needle into the area of the fracture and injecting cement. The cement that is used is the same substance that has been used for years to perform hip and knee replacements. By injecting the cement, the bone fragments are glued together and stabilized. This typically results in considerable, if not complete, pain relief.
Kyphoplasty is a similar procedure, but involves inserting balloons into the fractured bone and expanding the compressed vertebral body prior to injecting the cement.
Both procedures are performed on an outpatient basis. The procedure is performed under conscious sedation, meaning that sedatives are given through an IV. Following either procedure, the patient is observed for 2 or 3 hours at which point they are discharged home. Patients are asked to spend a quiet evening at home following the procedure, but bed rest is not required. Most patient’s express a significant improvement in their symptoms shortly after it is performed.
FAQs:
Is the procedure safe?
Both vertebroplasty and kyphoplasty are safe. While there is a small risk of neurological dysfunction, infection or bleeding, the overall safety profile is excellent with significant complication rates less than 2 %.
How long does the procedure take?
While the procedure takes 30 minutes, you can expect to be at the hospital for well over half of the day to allow for preparation and recovery time.
Does the fracture have to be new?
Generally speaking the fracture should be fairly new. If the fracture has essentially healed, vertebroplasty or kyphoplasty has no benefit. We ask for an MRI scan prior to either procedure to be certain that the fractures have not healed.
What kinds of tests are done before the procedure?
We ask that every patient get a MRI to be certain that the fracture has not healed. If a patient cannot have a MRI because of a pacemaker or other device, we may ask the patient to obtain a CAT scan first.
Can I have this if my fracture is caused by cancer?
Yes, this can be applied to fractures that have occurred because of cancer. However, the complication rate is higher and the success rate is somewhat lower for these patients.
Can the procedure be repeated?
Generally speaking, the procedure is not repeated for the same vertebral body. However, it can be performed multiple times in the same patient if he/she develops a new fracture at a different level.
How long do I have to wait until I notice an improvement?
Most patients feel significantly better by the time they are released to go home on the day of the procedure.