Kyphoplasty, The Latest Treatment For Vertebral Compression Fractures

Vertebral compression fractures may occur with major trauma, such as a motorcycle accident, or with something as insignificant as a sneeze, or stepping off of a curb. With a compression fracture, the bone compressed and collapses into itself, similar to squeezing a Styrofoam peanut between your fingers.

How much force it takes to cause a compression fracture, depends on the quality of the bone. Elderly women with osteoporosis have frail, thin bones, which are easily crushed. But even the young strong bone of an 18 year old, will collapse if sufficient force is applied. These fractures may also be caused by metastatic disease, and multiple myeloma, which can weaken the bone to the point that it simply collapses.

A large majority of these fractures are termed wedge fractures, which refers to the shape of the fractured vertebra. The anterior, or front part of the vertebra, is compressed, and the posterior or back portion maintains its height. But in some cases, when sufficient force is applied, the entire vertebra is flattened.

Compression fractures cause the sudden severe pain and disability. The compression fracture itself will generally cause only back pain, focused at the sight of the fracture. Occasionally, when fracture fragments are forced out of place and begin pressing on nerves, there may be buttock and lower extremity pain as well.

Historically, the treatment for these fractures has been bed rest, and pain medication. Depending on how stable the fracture was thought to be, sometimes a brace or body cast would be added. Young people were more likely to survive the period of immobility. In the elderly population, with multiple medical problems, there was a high rate of mortality from the immobilization. People often had complications with pneumonia, blood clots, and loss of muscle. In many cases, even though the fracture would heal, people were never able to return to regular activity.

In 1998 the first kyphoplasty was performed. This new procedure has been shown to restore the height of the vertebra, and quickly stabilize the fracture. There is almost an immediate reduction in pain making it possible to mobilize patients the day after surgery. Braces or body casts are generally not necessary.

This surgery is performed through a tiny 1/2 inch incision. A large needle is threaded precisely into the center of the damaged vertebra, using flouroscopic x-ray guidance. Then a balloon is inserted and inflated in the center of the fracture. This pushes the fracture fragments back out to their original position, re-establishing the dimensions of the vertebra, and correcting any deformity.

When the surgeon is satisfied with the shape and height of the vertebra, the balloon is deflated and withdrawn. The void that is left is then filled with methyl methacrylate, which is the same bone cement that is used to glue prosthetic joint replacements in place. Within minutes this hardens and immediately stabilizes the fracture fragments.

Most people are up the next day. If their pain is not completely resolved, is greatly improved. They are generally able to return to their normal activities within a few weeks.

There are risks with any surgery, but kyphoplasty is minimally invasive and the risks are considered to be very low. It is reported that in up to 10% of cases some methyl methacrylate will extrude outside of the vertebra. In most cases this is harmless and does not cause any problems. The American Academy of Orthopedic Surgeons reports that in 1 case in 10,000 this cement may damage or irritate nerves or the spinal cord. A second surgery may be required to remove the excess cement.

The benefits of this procedure are that it greatly shortens the time of pain and disability that people with compression fractures are forced to endure. Because people are mobilized the day after surgery, it greatly reduces the risk of complications associated with prolonged bed rest.

When comparing the risks and benefits of using kyphoplasty to treat a vertebral compression fracture. The benefits seem to outweigh the risks, and this procedure may be worth considering.

Vertebral compression fractures may occur with major trauma, such as a motorcycle accident, or with something as insignificant as a sneeze, or stepping off of a curb. With a compression fracture, the bone compressed and collapses into itself, similar to squeezing a Styrofoam peanut between your fingers.

How much force it takes to cause a compression fracture, depends on the quality of the bone. Elderly women with osteoporosis have frail, thin bones, which are easily crushed. But even the young strong bone of an 18 year old, will collapse if sufficient force is applied. These fractures may also be caused by metastatic disease, and multiple myeloma, which can weaken the bone to the point that it simply collapses.

A large majority of these fractures are termed wedge fractures, which refers to the shape of the fractured vertebra. The anterior, or front part of the vertebra, is compressed, and the posterior or back portion maintains its height. But in some cases, when sufficient force is applied, the entire vertebra is flattened.

Compression fractures cause the sudden severe pain and disability. The compression fracture itself will generally cause only back pain, focused at the sight of the fracture. Occasionally, when fracture fragments are forced out of place and begin pressing on nerves, there may be buttock and lower extremity pain as well.

Historically, the treatment for these fractures has been bed rest, and pain medication. Depending on how stable the fracture was thought to be, sometimes a brace or body cast would be added. Young people were more likely to survive the period of immobility. In the elderly population, with multiple medical problems, there was a high rate of mortality from the immobilization. People often had complications with pneumonia, blood clots, and loss of muscle. In many cases, even though the fracture would heal, people were never able to return to regular activity.

In 1998 the first kyphoplasty was performed. This new procedure has been shown to restore the height of the vertebra, and quickly stabilize the fracture. There is almost an immediate reduction in pain making it possible to mobilize patients the day after surgery. Braces or body casts are generally not necessary.

This surgery is performed thru a tiny 1/2 inch incision. A large needle is threaded precisely into the center of the damaged vertebra, using flouroscopic x-ray guidance. Then a balloon is inserted and inflated in the center of the fracture. This pushes the fracture fragments back out to their original position, re-establishing the dimensions of the vertebra, and correcting any deformity.

When the surgeon is satisfied with the shape and height of the vertebra, the balloon is deflated and withdrawn. The void that is left is then filled with methyl methacrylate, which is the same bone cement that is used to glue prosthetic joint replacements in place. Within minutes this hardens and immediately stabilizes the fracture fragments.

Most people are up the next day. If their pain is not completely resolved, is greatly improved. They are generally able to return to their normal activities within a few weeks.

There are risks with any surgery, but kyphoplasty is minimally invasive and the risks are considered to be very low. It is reported that in up to 10% of cases some methyl methacrylate will extrude outside of the vertebra. In most cases this is harmless and does not cause any problems. The American Academy of Orthopedic Surgeons reports that in 1 case in 10,000 this cement may damage or irritate nerves or the spinal cord. A second surgery may be required to remove the excess cement.

The benefits of this procedure are that it greatly shortens the time of pain and disability that people with compression fractures are forced to endure. Because people are mobilized the day after surgery, it greatly reduces the risk of complications associated with prolonged bed rest.

When comparing the risks and benefits of using kyphoplasty to treat a vertebral compression fracture. The benefits seem to outweigh the risks, and this procedure may be worth considering.

David Stevens PA-C
Living with Back Pain