Vertebral compression fractures are extremely common and may lead to back pain so severe it requires hospitalization in otherwise healthy active seniors. This is usually caused by a progressive weakening of the bone that occurs with normal aging- a condition called osteoporosis. The pain and loss of movement that often accompany bone fractures of the spine are perhaps the most feared and debilitating side effects of osteoporosis. For many people with osteoporosis, a spinal fracture means severely limited activity, constant pain and a serious reduction in the quality of their lives.
There are 10 million people in the U.S. who suffer from osteoporosis and another 28 million with thinning bones that put them at risk for fractures. This leads to approximately 700,000 vertebral fractures each year, usually occurring in women over the age of 60 (80 percent of those affected are women.) At least 25 percent of women and a somewhat smaller percentage of men over the age of 50 will suffer one or more spinal fractures during their lifetime.
Younger people also suffer these fractures, particularly those whose bones have become fragile due to the long-term use of corticosteroids or other drugs.
Because surgery on the spine is extremely difficult and risky, it has typically not been used to treat vertebral fractures associated with osteoporosis except as a last resort. Until recently, reduced activity and pain medications, many of which cause problematic side effects, or invasive (and often unsuccessful) back surgery were virtually the only treatments available.
Today, however, there is a safe, non-surgical treatment called vertebroplasty (ver-TEE-bro-plasty) that has been shown to be extremely effective in reducing or eliminating the pain caused by spinal fractures.
Vertebroplasty is a procedure done by interventional radiologists for vertebral compression fractures that fail to respond to conventional medical therapy. It is a non-surgical treatment that is performed using fluoroscopic (X-Ray) imaging guidance by interventional radiologists. Vertebroplasty stabilizes the collapsed vertebra with the injection of medical-grade bone cement into the spine. This improves pain, and can prevent further collapse of the vertebra, thereby preventing the height loss and spine curvature commonly seen as a result of osteoporosis. Vertebroplasty dramatically improves back pain within hours of the procedure and provides long-term pain relief and has a low complication rate as demonstrated in multiple studies.
If the vertebra isn't treated, it can heal in a compressed or flattened wedge shape (vertebra plana). Once this occurs, the compression fracture cannot be treated. It is very important for someone with persistent spinal pain lasting more than three months to consult an interventional radiologist.
Because bone loss occurs without symptoms, it is sometimes called a "silent disease". People may not know they have osteoporosis until their bones become so weak that a simple strain, twist of the body, bump or fall causes a bone fracture. Fractures may occur in the hip, wrist, ribs or elsewhere, but the most common site of fracture is in the vertebrae, the bones that make up the spinal column.
Among individuals with osteoporosis, there will be 700,000 painful spinal fractures each year. These so-called "compression" fractures are caused when the weakened vertebrae of the spine collapse — usually in the middle (thoracic) or lower (lumbar) spine. A collapsed vertebra may initially be felt as severe back pain. When more than one vertebra collapses, loss of height or spinal deformities such as kyphosis ("widow's hump") or stooped posture may result. In some cases, the fracture stabilizes on its own, and the pain goes away. But for many, the pain persists because the crushed bone continues to move and break, sometimes pressing on the spinal cord
- Being female
- Advanced age
- Family history
- Post- menopausal
- Amenorrhea
- Anorexia or bulimia
- A diet low in calcium
- Long-term use of corticosteroids or anticonvulsants
- Lack of exercise
- Smoking
- Excessive use of alcohol
Vertebroplasty was first performed in France in 1984 to stabilize compression fractures caused by bone tumors or metastasis. Accidentally, it was discovered that over 85% of these patients also experienced significant or complete resolution of their pain.
As a result the procedure was later applied to treat osteoporotic compression fractures and was found to be even more effective at treating the pain. Percutaneous Vertebroplasty was then introduced in the United States in 1994 and has become widely available since 1997 as a treatment for pain associated with compression fractures due to osteoporosis. The procedure has been shown to provide continued pain relief for osteoporotic compression fractures. A 1998 study by Dr. Deramond and colleagues reported on 80 patients with rapid and complete pain relief in more than 90 percent of osteoporotic cases. The follow-up in this patient population ranged from one month to 10 years with evidence of prolonged pain relief. Vertebroplasty is likely to become a standard of care for treating osteoporotic compression fractures as more patients and physicians become aware of the new advances in interventional radiology.
Vertebroplasty is an outpatient procedure using fluoroscopic (X-ray) imaging and conscious sedation. The interventional radiologist inserts a needle about the size of a cocktail straw through a small nick in the skin on the back, directing it under fluoroscopy into the fractured vertebra. The radiologist then injects a medical-grade bone cement into the vertebra, filling the marrow cavity. Vertebroplasty usually takes less than one hour to perform depending on how many bones are treated. The cement hardens within 15 minutes and stabilizes the fracture.
All Vertebroplasty procedures are performed in our hospital locations at Virtua Marlton and Voorhees.
Following the procedure, the patient is recovered for four hours in our dedicated radiology recovery room. Some patients experience immediate pain relief after vertebroplasty. Most report that their pain is gone or significantly better within 48 hours. Many people can resume their normal daily activities immediately.
Vertebroplasty is extremely safe. Although it is a relatively new treatment in the U.S, our radiologists have been performing the procedure for more than a decade with excellent results. The injection technique also has been successfully used to treat other conditions in the spine. For example, it is used to treat cancer and blood vessel abnormalities. The bone cement used to stabilize the fractured vertebrae is used in joint replacement surgeries and other orthopedic procedures.
People who have suffered recent compressing fractures that are causing them moderate to severe back pain are the best candidates for Vertebroplasty. In some cases, older fractures may be treated, but the procedure is most successful if it is performed soon after the fracture occurs. The procedure is not used to treat chronic back pain or herniated disks.
Studies have shown that from 75 percent to 90 percent of people treated with Vertebroplasty will have complete or significant reduction of their pain.
Patients are able to ambulate after the procedure and usually are restricted to light activities for the first 48 hours. After this, they may resume their normal activities of daily living. Exercise may be resumed in one week.
Vertebroplasty is a very safe procedure with far fewer risks or complications compared to conventional spine surgery. In many studies, no complications were reported. As with any medical procedure, the possibility of complications will depend on the individual patient. For example, patients with tumors in the spine or with other serious medical conditions may be at higher risk for complications from Vertebroplasty. You should always ask your doctor to discuss risks and complications with you before you undergo any procedure.
A number of new approaches to Vertebroplasty are in development and once again we are in the forefront. A new procedure called Kyphoplasty (Spineology) is now available in which cadaveric bone graft is inserted into the fractured vertebra, both restoring height and stimulating bone growth. Please call us for a consult.
