Living With Vertebral Fractures - Coping With Fractures: Osteoporosis

Two procedures for vertebral fractures

There is growing interest in two procedures to stabilize compressed vertebrae and alleviate the pain associated with this type of fracture. Vertebroplasty and kyphoplasty are geared toward patients who haven't responded to traditional measures such as bed rest and pain medications. However, these techniques are still not commonly performed in the United States, and there is some concern about side effects.

Vertebroplasty, developed in France in the 1980s, is done on an outpatient basis and takes less than an hour. After the patient is given mild sedation, the physician inserts a needle into the affected vertebra, using an x-ray as a guide. Then bone cement, called methylmethacrylate, is injected into the compressed vertebra, filling the holes and crevices. The cement hardens in about 15–20 minutes, stabilizing the vertebra, creating a support that helps prevent any further collapse, and alleviating pain.

While side effects are uncommon, complications can include infection, bleeding, and compression of adjacent nerve tissue. Some small studies have been done on vertebroplasty, and the results indicate that in most patients the procedure significantly reduces pain and helps prevent another collapse.

Even newer on the scene is kyphoplasty (see illustration), a refinement of vertebroplasty. Like vertebroplasty, this procedure is aimed at stabilizing compressed vertebrae and relieving pain. But it also restores the height of the vertebra and reduces deformity in the spine. Kyphoplasty was developed to address the weaknesses of vertebroplasty, including the risk for cement leakage and the procedure's inability to restore the height loss caused by compression fractures.

Like vertebroplasty, kyphoplasty takes less than an hour, although the patient may need to remain in the hospital overnight. In this procedure, after the patient receives mild sedation, a physician inserts a small tubelike instrument into the affected vertebra, using a special viewing device called a fluoroscope as a guide. Once the instrument is correctly placed, a balloon is 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 of the cement leaking and pushes the vertebral endplates apart, restoring some height.

While data on kyphoplasty are limited, in one study it provided significant pain relief in more than 95% of patients.

Generally, complications are uncommon, but if the bone cement leaks into the bloodstream or spinal canal, serious problems can occur. In 2002, the FDA warned that soft tissue damage, nerve root pain and compression, pulmonary embolism, and respiratory and cardiac failure have been reported among some patients undergoing these procedures. According to the FDA, not enough information is available to assess the safety and effectiveness of the different bone cements used or the overall risks and benefits of these procedures. If you are considering these procedures, it's wise to keep in mind that more research is needed to clarify their benefits and potential side effects.

Technique to relieve pain

Kyphoplasty is one of the most recent advances in treating the pain associated with vertebral compressions. This technique also restores the height of the treated vertebra. First, a tube is inserted into the vertebra (A). Then a balloon at the end is inflated and deflated, leaving a hollow in the bone (B). Finally, surgical cement is injected into the cavity, shoring up the vertebral endplates. This procedure is not being done extensively, and more research on it is needed.