SAINT THOMAS HEALTH MEDICAL MONDAYS
Monday, May 13, 2013
TOPIC: Compression Fractures & Kyphoplasty
Dan Wunder, MD | interventional radiologist
News notes via www.WebMD.com
Vertebroplasty & Kyphoplasty | Topic Overview
After giving you a local anesthetic, the doctor puts a needle into your vertebrae and injects a substance that works like cement.
The doctor guides the needle using fluoroscopy. This is a test that can be used to position a needle for a procedure. Vertebroplasty takes 1 to 2 hours. The injection usually takes only about 10 minutes.
The cement mixture hardens in about half an hour. You likely will go home the same day. You may take some pain medicine for a couple of days.
This surgery can be used to return your vertebrae to a more normal shape.
Your doctor may numb the area, or you may get medicine to make you sleep. The doctor makes a small cut in your back and puts a balloon device into the fractured vertebra. The doctor inflates the balloon and then deflates it. Then he or she puts the cement substance into the space created by the balloon. It takes 1 to 2 hours to treat each vertebra.
You may go home that day, or you may spend the night in the hospital.
How well do these surgeries work?
Only a few studies have been done on these surgeries. One study showed that people who had vertebroplasty for recent compression fractures noticed pain relief right away.1 Two other studies, involving people with painful compression fractures from osteoporosis, compared those who got the cement to those who didn't. In these two groups, there was not much difference in their pain or their ability to be active.2, 3
Because the surgeries are still somewhat new, it's not known how well they work over time.
Possible problems from the surgeries include:
Problems are more common when more than one vertebra is treated at the same time.
Symptoms of a Spinal Compression Fracture
It is important to identify the symptoms of spinal compression fractures and notify your doctor right away. Sudden, severe back pain, especially in older women, may signal a spinal compression fracture or another serious condition.
Anyone with significant back pain -- especially a woman who is near or over age 50 -- should see a doctor. Most compression fractures in women over 50 are due to osteoporosis and treatment can help reduce the chance of further compression fractures.
One or more symptoms can indicate a spinal fracture:
The pain typically occurs with a slight back strain during an everyday activity, like:
Different Signs of Spinal Compression Fracture Pain
The pain experience of a spinal compression fracture can vary. For many people, the pain will subside while the bone is healing. That can take up to two or three months. Other people will continue feeling pain, even if the fracture has healed.
Not everyone feels a clear-cut spinal pain when a fracture occurs.
In some cases, there is virtually no pain involved with spinal compression fractures. The fractures may occur so gradually that the pain is relatively mild or unnoticeable. For some people, the pain may evolve into a chronic back ache in the injured area. For others, the gradual curving of the spine is the first indication that multiple fractures have occurred.
Signs of Multiple Spinal Compression Fractures
When multiple spinal compression fractures have occurred, there is considerable change in the spine. This can affect the internal organs and body functions:
The symptoms of spinal compression fractures are obviously different for every person.
Treatment for Spinal Compression Fractures
All components of treatment have improved greatly in the last decade, says Michael Schaufele, MD, a physiatrist and professor of orthopaedics at Emory University School of Medicine in Atlanta. "We have better interventional options to treat fractures and better treatments to prevent future fractures," he tells WebMD.
The majority of fractures heal with pain medication, reduction in activity, medications to stabilize bone density, and a good back brace to minimize motion during the healing process. Most people return to their everyday activities. Some may need further treatment, such as surgery.
Nonsurgical Treatment for Spinal Compression Fractures
Pain from a spinal compression fracture allowed to heal naturally can last as long as three months. But the pain usually improves significantly in a matter of days or weeks.
Pain management may include analgesic pain medicines, bed rest, back bracing, and physical activity.
Pain medications. A carefully prescribed "cocktail" of pain medications can relieve bone-on-bone, muscle, and nerve pain, explains F. Todd Wetzel, MD, professor of orthopaedics and neurosurgery at Temple University School of Medicine in Philadelphia. "If it's prescribed correctly, you can reduce doses of the individual drugs in the cocktail."
Over-the-counter pain medications are often sufficient in relieving pain. Two types of non-prescription medications -- acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) -- are recommended. Narcotic pain medications and muscle relaxants are often prescribed for short periods of time, since there is risk of addiction. Antidepressants can also help relieve nerve-related pain.
Activity modification. Bed rest may help with acute pain, but it can also lead to further bone loss and worsening osteoporosis, which raises your risk for future compression fractures. Doctors may recommend a short period of bed rest for no more than a few days. However, prolonged inactivity should be avoided.
Back bracing. A back brace provides external support to limit the motion of fractured vertebrae -- much like applying a cast on a broken wrist. The rigid style of a back brace limits spine-related motion significantly, which may help reduce pain. Newer elastic braces and corsets are more comfortable to wear but don't work, says Wetzel. "There's an old saying, 'The inconvenience of the brace is directly proportional to its effectiveness,'" he tells WebMD. However, braces should be used cautiously and only under a doctor's supervision. Weakening and loss of muscle can occur with excessive use of braces for lumbar conditions.
Osteoporosis treatment . Bone-strengthening drugs such as bisphosphonates (such as Actonel, Boniva, and Fosamax) help stabilize or restore bone loss. This is a critical part of treatment to help prevent further compression fractures.
Surgical Treatment for Spinal Compression Fractures
When chronic pain from a spinal compression fracture persists despite rest, activity modification, back bracing, and pain medication, surgery is the next step. Surgical procedures used to treat spinal fractures are:
Vertebroplasty and Kyphoplasty
These procedures for spinal compression fractures involve small, minimally invasive incisions, so they require very little healing time. They also use acrylic bone cement that hardens quickly, stabilizing the spinal bone fragments and therefore stabilizing the spine immediately. Most patients go home the same day or after one night's hospital stay.
Vertebroplasty. This procedure is effective for relieving pain from spinal compression fractures and helping to stabilize the fracture. During this procedure:
Kyphoplasty: This procedure helps correct the bone deformity and relieves the pain associated with spinal compression fractures. During the procedure:
"These procedures are amazing, when you look at how well patients do," says Rex Marco, MD, chief of spine surgery and musculoskeletal oncology at the University of Texas Health Science Center at Houston. "They're often in terrible, terrible pain, and it's not going away. But with two small incisions we can take care of something that needed a huge operation in the past but without really good results."
"We do everything we can to make the operation go as smoothly as possible," says Marco. "Antibiotics decrease the chance of infection. And a special x-ray machine helps us get the needle into the bone and assure that cement goes into the bone and stays in the bone."
Spinal Fusion Surgery
Spinal fusion surgery is sometimes used for spinal compression fractures to eliminate motion between two vertebrae and relieve pain. The procedure connects two or more vertebrae together, holds them in the correct position, and keeps them from moving until they have a chance to grow together, or fuse.
Metal screws are placed through a small tube of bone and into the vertebrae. The screws are attached to metal plates or metal rods that are bolted together in the back of the spine. The hardware holds the vertebrae in place. This stops movement, allowing the vertebrae to fuse. Bone is grafted into the spaces between vertebrae.
"Spinal fusion is often the last resort," Wetzel tells WebMD. "If the bone is more than 50% compressed in height, if patients are in a great deal of pain, and if they have had complications from another spinal surgery, we suggest spinal fusion surgery."