Treatment of Osteoporotic Vertebral Compression Fractures
The spine or backbone is made up of many bones called vertebrae. The front of the vertebrae is made up of square shaped vertebral body, disks and ligaments. The disks act to cushion the vertebrae.

THE PROBLEM
If the square vertebral body weakens or is injured with excessive force, it may break and flatten like a pancake causing back pain and misery. Osteoporosis (weak thin bones) is the major cause of vertebral body compression fractures; other less common causes include severe trauma, infection or cancer.

Pain is the most common complaint from spine fractures. Any movement causes micromotion in the broken bone producing severe pain. Pain usually decreases with lying down and increases with standing, walking and lifting. Sometimes people have no pain at all. Rarely fractures may cause numbness, weakness, paralysis or bowel and bladder dysfunction from spinal cord or nerve compression. Fortunately, the severe back pain usually improves during the first month after injury.

INVESTIGATIONS
Spinal fractures can be diagnosed by x-ray, CT, bone scan and MRI. Besides diagnosing the fracture, MRI scan can determine if the fracture is new, response to treatment and rule out nerve or spinal cord compression.

TREATMENTS
Patients who fail conservative treatment may benefit from surgical treatment. The key to surgical treatment is stabilizing the fracture. The spine like a broken arm must be “cast” to stop abnormal bone movement to prevent pain. Surgical options include vertebroplasty, kyphoplasty and major spine surgery. Major spine surgery is not commonly needed to treat osteoporotic compression fractures.

Vertebroplasty and kyphoplasty are the most common treatment for osteoporotic compression fractures. These procedures involve the placement of a large needle into the fractured vertebral body for the injection of liquid cement. Once the liquid cement hardens it stabilizes the vertebral body decreasing painful movements. If there is concern for cancer then bone biopsy can be done and sent off to be examined by pathology.

Vertebroplasty is an outpatient procedure, done under conscious sedation like a colonoscopy, but can be done under local anesthesia in high-risk patients or rarely general anesthesia. A medium sized needle is placed into the fractured vertebral body under x-ray guidance and then liquid plastic is slowly injected to harden and stabilize the fracture.

Kyphoplasty is similar to vertebroplasty, but kyphoplasty is usually done under general anesthetic and requires an over night admission. Kyphoplasty involves the placement of two large needles and balloons into the broken vertebra under x-ray. The balloons are slowly inflated to expand the collapsed “pancake” vertebral body and create cavities to hold the plastic. Plastic is then injected after the balloons are removed to support and stabilize the broken vertebrae.