Most often seen in patients with osteoporosis, spinal compression fractures occur when the vertebrae lack sufficient strength to support the spine. This can also happen as a result of trauma (such as a severe fall or car crash) or cancer that has spread to the bones. Actions such as lifting, slipping, falling, and even sneezing or coughing can put brittle vertebrae at risk of fracture.
While these fractures can be very small, a number of them together can weaken, shorten, and alter the shape of the spine. Because the back of a vertebra is stronger than the front, compression fractures happen more often in the front of the bone, leaving wedge-shaped vertebrae that contribute to a stooped posture, a condition called kyphosis (more commonly known as “dowager’s hump”).
Vertebroplasty and balloon kyphoplasty are two minimally invasive procedures used to treat spinal compression fractures. Which procedure is chosen depends on the severity and location of the fracture and amount of time that has passed since it occurred. Using fluoroscopy, a type of moving X-ray image, the doctor injects bone cement into the fractured vertebra to create an internal cast and stabilize the fracture. For balloon kyphoplasty, the physician first inserts a balloon into the fracture using a hollow needle, inflating the balloon to create a cavity that is then filled with bone cement. This is all done through a small nick in the skin. Stabilizing the spine in this way can help to relieve pain, prevent deformity, and reduce the risk of additional fractures.
Approximately 9 out of 10 patients who undergo these procedures gain mobility and experience reduced levels of pain, allowing these patients to increase their strength and use fewer narcotics. Many patients report significant pain relief immediately following the procedure or within a few days; for some, symptoms disappear entirely. Increased mobility helps to combat osteoporosis and reduce the risk of pneumonia for patients where were formerly bedridden. Often, patients are able to return to their previous levels of activity with no need for physical therapy or rehabilitation.
The rate of complications from vertebroplasty and kyphoplasty is low. Any procedure that breaks the skin introduces a chance of infection; however, the odds of contracting an infection that requires antibiotics as a result of these procedures appears to be less than 1 in 1,000. The procedures also carry a small risk of cement leakage, increased pain, numbness, or paralysis. If you’re considering vertebroplasty or kyphoplasty, your physician should fully explain the risks and benefits involved prior to the procedure.
Before the procedure, an MRI is preformed to determine the extent and location of the fracture. For patients who cannot undergo MRI, a DEXA scan is used. For the procedure itself, patients should plan for one hour for each fracture to be repaired plus three to four hours in recovery before they are released to go home. Normal activities can be resumed the following day.
During the procedure, the patient lies face down on the operating table and receives IV sedation through a vein in the arm. This helps patients relax and feel comfortable, and while sleepiness is common, patients typically remain conscious throughout the procedure. The area of the back to be treated is cleaned, shaved, and numbed. The interventional radiologist then makes a small incision in the back to access the damaged vertebra and inject the cement. The bone cement hardens in just about 15 minutes, and the small incision is stitched. Before being released, the patient will receive any aftercare instructions they may need.
Iowa Radiology performs vertebroplasty and kyphoplasty for patients in the Des Moines area. Contact our office if you have any questions about the procedure.
Sources
Causes of Spinal Compression Fractures. WebMD. https://www.webmd.com/osteoporosis/guide/spinal-compression-fractures-causes#1. Published March 10, 2019. Accessed September 17, 2019.
Jenis, Andrew, M.D. Vertebral Compression Fracture. Emedicinehealth. https://www.emedicinehealth.com/vertebral_compression_fracture/article_em.htm#vertebral_compression_fracture_causes. Accessed September 17, 2019.
Vertebroplasty & Kyphoplasty. Radiologyinfo.com. https://www.radiologyinfo.org/en/info.cfm?pg=vertebro. Updated January 23, 2019. Accessed September 17, 2019.