Surgery For Compression Fractures - When Surgery Is An Option: Back Pain

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Surgery for compression fractures

Vertebral compression fractures from osteoporosis mainly affect postmenopausal women. About one in four postmenopausal women has had such a fracture. The standard treatment was — and still is — to wait it out while the fractured bone heals. This process can take six weeks on average and is very painful; often narcotic painkillers are necessary to provide relief.

But two more procedures for treating vertebral fractures have emerged and grown in popularity: vertebroplasty and kyphoplasty. In many cases, these procedures quickly alleviate pain from spinal fractures, often as soon as the same day.

Vertebroplasty and kyphoplasty are suitable to treat only compression fractures, not other types of back problems, and are usually recommended to people who cannot tolerate the more conservative measures of rest and pain medications. And while short-term benefits are promising — if not dramatic for some people — more research is needed to determine the long-term benefits and risks associated with the two techniques.

Vertebroplasty

This technique, which was developed in France and first introduced in the United States in 1993, is done on an outpatient basis and takes less than an hour. After you receive mild sedation, the physician inserts a needle into the compressed vertebra, using an x-ray for guidance. The surgeon injects bone cement, called methylmethacrylate, into the vertebra, filling the holes and crevices. The cement hardens in about 20 minutes, stabilizing the vertebra, creating a support that helps prevent any further collapse, and alleviating pain.

Side effects have not commonly been reported, but complications could include infection, bleeding, and leakage of the cement, causing compression of adjacent nerve tissue. A number of short-term studies have been done on vertebroplasty, and the results indicate that the procedure is safe and for most people significantly reduces pain and helps prevent another collapse. But as yet there are no results from long-term studies. It's also important to note that vertebroplasty has several weaknesses, including the risk of cement leakage and an inability to restore the height loss caused by compression fractures.

Kyphoplasty

This procedure is a refinement of vertebroplasty, offering several advantages. Like vertebroplasty, kyphoplasty aims to stabilize compressed vertebrae and relieve pain. But it also restores the height of previously compressed vertebrae and reduces spinal deformity.

Kyphoplasty takes less than an hour, although you may need to remain in the hospital overnight. After you receive mild sedation, the physician inserts a small tube-like instrument into the affected vertebra, using a special viewing instrument called a fluoroscope as a guide (see Figure 14). Once the instrument is correctly placed, a balloon is inserted and inflated, creating a cavity in the bone. The balloon is then deflated, and the physician injects surgical cement into the void. The creation of this hollow minimizes the risk that the cement will leak and pushes the vertebral endplates apart, thus restoring some height. Thus far, the few studies conducted on kyphoplasty indicate the procedure is safe and provides pain relief.

Figure 14: A look at kyphoplasty In kyphoplasty, a surgeon first inserts a tube into the vertebra (A), then inflates and deflates a balloon at the end of the tube to leave a hollow in the bone (B). The surgeon then injects surgical cement into the cavity, shoring up the vertebral endplates.

Remaining questions

Although to date most studies on vertebroplasty and kyphoplasty have been positive, the techniques don't work for everyone, and sometimes pain relief is disappointingly short-lived, for reasons not yet understood.

In the absence of long-term studies, concerns about the two techniques remain:

• Will "fixing" one vertebra have a detrimental effect on neighboring vertebrae?

• What, if any, will be the long-term effect of "interfering" with the mechanics of the spine?

• Will simply repairing one fractured vertebra without treating the underlying cause of the fracture — osteoporosis — mean that other fractures will follow?

Last updated:	January 23, 2007