A New Treatment Option for Refractory Vertebral Compression Fractures
Vertebral compression fracture [VCF] is the most common complication of osteoporosis.
Over 750,000 compression fractures are recorded per year at an average yearly
cost of 750 million dollars. Fortunately, most compression fractures are benign.
The acute pain of the fracture resolves with medical management; a few days
of bed rest, Calcitonin and pain medications allow most patients to return to
their activities of daily living.
A finite number of patients, however, are left with long term sequelae from
their VCF. The kyphotic deformity [i.e., stooped over position] commonly seen
with multiple thoracic VCF can lead to chronic thoracic and low back pain. The
abnormal kyphoses increases the work load of the paraspinal muscles which leads
to chronic pain and fatigue.
Furthermore, deformity causes compression of the viscera; this compression
results in early satiety and weight loss in this population. The lung’s
functional capacity is also significantly reduced; each VCF causes a 9% loss
of forced vital capacity. Patients with multiple VCFs are at significantly increased
risk of pneumonia as well.
Finally, multiple studies have confirmed the increased mortality risk associated
with VCF. When compared to controls, patients with VCF had a 5 year survival
of 61% compared to 76% for their matched peers. A study of 9,575 women followed
for over 8 years demonstrated a 23% increased mortality rate compared to patient
without VCF [Figure 2].
With the recent advances in spinal surgery, it is not surprising that a viable,
minimally-invasive option is now available to help patients with refractory
VCF. The ideal treatment for a VCF would be to stabilize the fracture while
correcting the deformity. Previously, surgical intervention was only indicated
in cases with pending or present neurological compromise.
A new technique of percutaneous stabilization of vertebral fractures [Kyphoplasty],
however, allows for restoration of the vertebral body height with injection
of cement to stabilize VCFs. The patient is placed in a prone position. Using
fluoroscopy, the surgeon introduces a cannula into the vertebral body through
the pedicle posteriorly. A balloon is subsequently utilized to inflate and “jack
up” the vertebrae to its normal, non compressed height. Subsequently,
cement is injected into the void to prevent future collapse. [Figures 1 and
The procedure is fairly quick [about 45 minutes per level] and is tolerated
very well by the patients. Most patients wake up in recovery room with their
back pain significantly improved. Often, they are able to leave the hospital
on the first postoperative day with no further need for medical attention.
· Most vertebral compression fractures resolve with medical management;
· Kyphoplasty is a minimally-invasive procedure to help patients with
refractory compression fractures;
· Patients who fail at least 2 weeks of conservative management are good
candidates for Kyphoplasty;
· 90% of patients have significant pain improvement with the procedure
which is fairly quick and well tolerated with overnight hospital stay.
Figure 1: The common pathway for worsening symptoms with compression fractures.
Figure 2 and 3: With Kyphoplasty, a tube is introduced into the broken vertebrae
which can be lifted back to its pre-fracture shape.