Spinal Bone Fractures
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Vertebroplasty
Treating Spinal Fractures Without Surgery
Osteoporosis and Spinal Fractures
What Is Osteoporosis?
Osteoporosis is a condition in which bones become thin and fragile. It is called a "silent disease" because bone loss occurs without symptoms. People may not know they have osteoporosis until their bones become so weak that a simple strain, twist of the body, bump or fall causes a bone fracture. Fractures may occur in the hip, wrist, ribs or elsewhere, but one of the more common sites is in the vertebrae, the bones that make up the spinal column. The pain and loss of movement that often accompany bone fractures of the spine are perhaps the most feared and debilitating side effects of osteoporosis. For many people with osteoporosis, a spinal fracture means severely limited activity, constant pain and a serious reduction in the quality of their lives.
How Common Are Spinal Fractures Caused by Osteoporosis?
There are 10 million people in the United States who suffer from osteoporosis and another 28 million with thinning bones that put them at risk for fractures. Eighty percent of those who are at risk and affected by the disease are women. Osteoporosis causes more than 1.5 million fractures a year, of which 700,000 are spinal (vertebral) fractures.
Who Is at Risk?
Researchers estimate that at least 25 percent of women and a somewhat smaller percentage of men over the age of 50 will suffer one or more spinal fractures. Younger people also suffer these fractures, particularly those whose bones have become fragile due to the long-term use of steroids or other drugs to treat a variety of diseases such as lupus, asthma and rheumatoid arthritis. Significant risk has been reported in all ethnic groups, and while osteoporosis is most common in old age, it can occur at any time.
Factors that increase the likelihood of developing osteoporosis include:
- being female
- being thin or having a small frame
- advanced age
- a family history of osteoporosis
- being past menopause
- abnormal absence of menstrual periods
- anorexia or bulimia
- a diet low in calcium
- long-term use of medications such as corticosteroids or anticonvulsants
- lack of exercise
- smoking
- excessive use of alcohol
How Are Spinal Fractures Treated?
Fractures of the vertebrae have traditionally been much more difficult to manage than broken bones in the hip, wrist or elsewhere that can often be treated successfully with surgery. Surgery on the spine has typically not been used to treat vertebral fractures associated with osteoporosis, except as a last resort. Until recently, reduced activity and pain medications were virtually the only treatments available. For those patients who have unresolved pain, there is a safe, non-surgical minimally invasive treatment called vertebroplasty (ver-TEE-bro-plasty) that offers new hope. Studies show that about 90 percent of people treated with vertebroplasty have complete or significant reduction of their pain.
Image courtesy and copyright of Society of Interventional Radiology.
In the procedure, a needle is inserted through the skin and into the collapsed vertebrae. A special bone cement used for medical purposes (called polymethylmethacrylate) is injected into the bone to stabilize it. Often, more than one fractured vertebrae can be treated in a single procedure. Open surgery is not required because the interventional radiologist is able to guide the needle to the spot using special X-ray equipment.
Vertebroplasty takes from one to two hours to perform, depending on how many bones are treated. Usually, the procedure may be performed with mild sedation and local anesthetic that numbs the treated area.
Some patients experience immediate pain relief after vertebroplasty. Most report that their pain is gone or significantly better within 48 hours. Many people can resume normal daily activities within hours to days after treatment.
What Are the Risks or Complications?
Vertebroplasty is a very safe procedure with few risks. Complications are rare and should be discussed with your doctor. As with any medical procedure, the possibility of complications will depend on the individual patient. For example, patients with tumors in the spine or with other serious medical conditions may be at higher risk for complications from vertebroplasty. Your interventional radiologist will work closely with your primary care doctor to be sure you receive the best possible care.
Who Is a Candidate for Vertebroplasty?
People who have suffered recent fractures that are causing severe back pain despite standard therapy with rest and pain medications are the best candidates for vertebroplasty. Older fractures may be treated, but the procedure is most successful if it is performed within one year of when the fracture occurs. The procedure is not used to treat arthritis or herniated disks.
Will Vertebroplasty Treat or Prevent Loss of Height or "Widow's Hump?"
After a vertebra has fractured, there is typically a loss of only 20 to 30 percent of the height of the bone. But over several weeks, fractures may reoccur and the vertebra flattens out, until eventually there is a 70 to 90 percent loss of height in the bone. Gradually, the back hunches over and the person loses height, especially if several vertebrae are involved. Vertebroplasty cannot reverse this loss of height or kyphosis (often called "widow?s hump") in individuals who already have these conditions.
Some studies suggest that early treatment of spinal fractures with vertebroplasty can strengthen the spine and improve the posture, which may help prevent further fractures that lead to height loss or kyphosis. Currently, however, there is no evidence to prove that the procedure will prevent these problems. However, new research on the horizon is looking at ways to solve these problems.
How Long Does Vertebroplasty Take?
The length of time for the procedure depends on the number of vertebra being treated. However, vertebroplasty usually takes from one to two hours.
Is Vertebroplasty Painful?
Vertebroplasty is not painful. It usually is performed with mild sedation and local anesthesia. In some cases, a patient may be given general anesthesia. Most patients report that their pain is gone or significantly improved within 48 hours of the procedure. Others experience immediate relief following the procedure.
Excerpts were reprinted with permission of the Society of Interventional Radiology ©2004, www.sirweb.org .
