Issue 26.13
Spinal vertebral body compression fractures are a common complication of osteoporosis, a disease causing thinning of the bones. The body is constantly building up and breaking down bone. Peak bone density or bone mass is typically highest in the early 20’s and is optimized by dietary factors and weight bearing exercise. Risk factors for osteoporosis include: increasing age, female gender, post menopausal state, chronic corticosteroid use, thin frame, and Caucasian or Asian ethnicity. Osteoporosis most commonly affects the spine and hips. The bones can become so brittle that a minor fall or mild stresses such as bending or coughing can cause a fracture.
Osteoporosis is best diagnosed with a painless outpatient imaging procedure that shows the density of the bones of the hips and spine called a DEXA scan. Some symptoms of osteoporosis are a stooped posture, loss of height over time or severe pain from a compression fracture.
Treatment for osteoporosis includes: maintaining an active lifestyle, smoking cessation, as well as certain medications. A group of medications called bisphosphonates, such as Fosamax, Boniva and Reclast, are medications that help maintain bone strength. Other medications like Forteo can be used as well.
One of the most common debilitating complications of osteoporosis is compression fracture of the spine. As osteoporosis causes a weakening of the bones, those bones change from a density similar to a cinderblock to a density similar to soft wood. Therefore, sneezing, small falls, or even just rolling over in bed can cause one of these fractures. A compression fracture is best diagnosed with an MRI, but a CT and nuclear medicine bone scan can also be used. Symptoms are typically a 2-3 day onset of severe mid or low back pain following the fall or trauma. Most patients know what injury caused their fracture; however some patients develop the fracture with no known event.
Treatments for vertebral body compression fractures include: pain medication, back bracing, and vertebroplasty or kyphoplasty. Compression fractures can heal on their own over a 3-6 month period, however if left untreated the pain from a compression fracture can cause other related complications such as pneumonia, bed ulcers, and muscle loss as a result of inactivity due to the pain. Thus, most debilitating and painful compression fractures are best treated by vertebroplasty or kyphoplasty.
A number of studies have shown the benefits of vertebroplasty for severe pain caused by a compression fracture. A Mayo Clinic study showed vertebroplasty relieves pain, increase mobility and decrease the use of pain medication. Vertebroplasty is an outpatient procedure done under fluoroscopy or x-ray guidance where one or two needles are place into the middle of the fracture and bone cement is injected. Vertebroplasty is successful in relieving pain in approximately 90% of patients.
Kyphoplasty is an advanced procedure quite similar to vertebroplasty, however it is thought to be more safe and efficacious. Kyphoplasty is also an outpatient procedure done under x-ray guidance with small needles placed into the fracture. A small balloon is inserted into the fracture and inflated in order to restore the height of the compressed vertebral body. This restores the vertebrae to the original shape and size as much as possible. The balloon is then deflated and removed before the injection of bone cement. Kyphoplasty is preformed in a pain specialist’s office in about 30 minutes and then the patient is able to go home after recovering from light anesthesia.
Dr. Court Empey is a board certified interventional pain and spine specialist and founder of Desert Pain Specialists in St. George, Utah. (435) 216-7000.