Issue 22.14
Vertebral body compression fractures are one of the most painful conditions that I treat. These fractures can be caused by trauma, metastatic cancer or osteopenia, but are most commonly due to osteoporosis. Osteoporosis weakens bones and decreases the bone density. In other words, the spine bones are like cinderblocks when a patient is a teenager but with osteoporosis and aging become more like wood. Osteoporosis and compression fractures are most common in postmenopausal women.
Sneezing, falls or even just rolling over in bed can cause one of these fractures. Compression fractures are most common in the lower (lumbar) or mid (thoracic) spine. The pain usually comes on over several hours or days after a fall and is typically quite severe. Most patients know what injury caused their fracture; however some patients develop the fracture with no known event.
X-ray and CT can be used to diagnose a compression fracture, but rarely can be used to determine if a fracture is new (acute) or old (chronic). An acute compression fracture is best diagnosed by MRI. If a patient is unable to get an MRI due to pacemaker or other medical condition, the combination of a CT and bone scan can be used as well to diagnose an acute compression fracture.
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, increases mobility and decreases 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. The bone cement stabilizes the fracture and returns the bone density from “wood-like” to “cinderblock-like”. 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 effective. 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 performed in a pain specialist’s office in about 30 minutes and then the patient is able to go home after recovering from light anesthesia.
Kyphoplasty is my most gratifying procedure to perform. Typically I’ll meet a sweet senior patient who has a history of little or no previous spine problems and new onset of severe mid or low back pain after a fall. Over 90% of these patients are free of the severe pain within the first minutes to days after the procedure and show extreme gratitude. I hope that you never have a compression fracture, but if you do, a kyphoplasty can really help treat the pain.
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.