What is a vertebral compression fracture?
The spine is made up of many individual bones called vertebrae that stack together in a column. Just like other bones in the body, these vertebrae can fracture. A vertebral compression fracture is an injury that occurs when the main part of the vertebra, the vertebral body, experiences too much pressure and collapses in height. These fractures happen most often in the thoracic (upper back) and lumbar (lower back) regions of the spine.
What causes vertebral compression fractures?
Compression fractures in the spine generally occur when a vertebral body has been weakened due to osteoporosis or cancer. When a vertebra is weakened, everyday activities such as lifting a child, bending down to pick something up, or even sneezing can cause a fracture. When these fractures occur, the vertebral body collapses into a wedge shape. Vertebral compression fractures may cause severe back pain and limited mobility.
What are the treatment options?
Left to their own, vertebral compression fractures may heal on their own with conservative treatment and pain control. These may take up to several months. Vertebroplasty can speed up recovery time by stabilizing the fracture fragments. This can reduce pain allowing a patient to return sooner to their normal activities.
Who is a candidate for vertebroplasty?
A physical examination as well as addition imaging may be needed to tell if someone is a good candidate for vertebroplasty. Typically, our doctors recommend a MRI to look at the bones to tell if the procedure is technically possible and to see if there is active inflammation (edema). The ideal vertebroplasty patient is someone who is not improving with conservative therapy who has active inflammation on MRI.
What are the risks of vertebroplasty?
Vertebroplasty requires general anesthesia which carries its own risks. These risks can be higher in patient’s with additional medical conditions such as heart disease or other cardiovascular conditions. Additional risks include damage to the spinal cord or leakage of cement into the bloodstream. Our doctors will explain all of the risks of the procedure in detail during your consultation.
What happens during the procedure?
The procedure will be performed in an angiography suite. The patient is given anesthesia and placed faced down on the operating table. The skin is then cleaned and numbed. Using a real time x-ray (fluoroscopy), a needle is carefully passed into the vertebral body. Depending on the fracture, one or two needles may be used. Once the needles are in the correct position, cement is slowly injected. When the fracture has been filled, the needles are removed. For one fracture the procedure usually takes less than one hour. If a patient has multiple fractures, these can usually be treated during the same session.
After the procedure, the patient will remain in the recovery area for about 5 hours for observation and allow the cement to set. Most patients go home the same day, however sometimes an overnight stay is needed. Improvement in pain should occur within the first 1-2 days.
How effective is vertebroplasty?
While a study performed in 2009 showed no difference between vertebroplasty and conservative treatment, newer trials have shown that vertebroplasty is better than conservative treatment in the correct patients. The most recent VAPOUR trial published in the British Medical Journal Lancet in 2016, further confirms the effectiveness of vertebroplasty @ www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31341-1/fulltext