The Effect of Vertebral Compression Fractures on Posture
Patients with postmenopausal osteoporosis are at increased risk for vertebral compression fractures. Fortunately, today these fractures are much less common, at least among those women with postmenopausal osteoporosis identified and under active management for their condition. At the beginning of my career, the only two drugs available for osteoporosis were estrogen and calcitonin. Neither were of much benefit for treatment of the disease. I spent a lot of time in the hospital caring for women with vertebral fractures in those days.
Vertebral fractures still happen today even in women on the best treatments we have for osteoporosis. When they do, I refer them for Kyphoplasty. This is an outpatient surgical procedure done under anesthesia in a surgical center.
In panel A, the surgeon places the introducer into the collapsed vertebral body through a small hole in the back. In panel B, a balloon in the tip of the introducer is inflated moving the fractured bone out of the way. The balloon is then pulled back. In panel C, the surgeon gentle injects bone cement into the fractured space, stabilizing the bone from within. This stabilization of the fracture from the inside out is equivalent to placing a cast around a broken limb. It supports the broken bone and this provides significant relief of pain. It allows the patient to resume some normal activities almost immediately after the procedure.
The key to success with this procedure as with most surgical operations is to have an experienced surgeon perform it. There was one manufacturer of the medical device to perform the procedure, now there are several. They have all trained as many orthopedist, neurosurgeons, and pain management doctors as possible to do the procedure. Interventional radiologists who work in hospitals offer a competing procedure called vertebroplasty. Since patients in severe pain with an acute back fracture may decide to go to the ER for help, the radiologist on call might get a chance to do the procedure. The problem with so many people trained to do a procedure with fewer people having fractures because of better treatment, is very few doctors can become really good at doing it.
There are also some other controversy surrounding which procedure is best, Kyphoplasty or vertebroplasty and which is safest. There is a lack of adequate placebo controlled trials for either procedure. There is a concern raised by critics of the procedure that the cement hardens to bone so much in the treated vertebra it becomes a cause for the vertebral body above or below to collapse.
I have investigated all this as thoroughly as possible and have come to the following conclusions. Kyphoplasty is safer than vertebroplasty. Kyphoplasty treatment relieves pain caused in compressed vertebra by stabilizing the fracture and cauterizing the nerve tissue within the vertebral body by the exothermic reaction of the bone cement as it polymerizes. The reason adjacent vertebra fracture is because they are subject to the same fracture promoting conditions that caused the treated vertebra to fracture in the first place. About 4 out of 5 patients I refer to a surgeon experienced in kyphoplasty have a good result with the procedure.
Medicare and commercial insurance carriers usually cover the kyphoplasty procedure, surgical center charges, and doctor’s fee.
Those who do well with kyphoplasty are out of bed right away. They are back carrying out their usual activities within a week or two. They are out walking again and doing other light exercise after that. It is very important that women with spine fractures get back on their feet as soon as possible to prevent them from becoming physically deconditioned. Even a few weeks of bed rest can have a devastating effect on both muscle and bone mass.
Women with painful vertebral fractures recover over months without kyphoplasty. It can take as few as 3 months in those with low-grade fractures and much longer with high-grade fractures. Some women develop chronic back pain after a fracture.
In Atlanta, the group I refer my patients to for kyphoplasty is Alliance Spine. Visit them on the web at www.spinepains.com.