November 14, 2018
Vertebral Fracture Surgery

Vertebral Fracture Surgery

by Berkeley Wellness  

Vertebral compression fractures (commonly a consequence of osteoporosis) primarily affect menopausal and postmenopausal women (although men are not immune). The conventional approach to treatment is to cope with the pain during the time it takes for the fracture to heal (usually about six weeks) using pain relievers. There are some new treatment alternatives, however, that can provide relief almost right away.

These options, known as percutaneous vertebroplasty and kyphoplasty, are appropriate only for the treatment of compression fractures (not other causes of back pain) and are generally recommended only for those who simply cannot tolerate the pain they continue to experience using the more conservative treatments.

Percutaneous vertebroplasty: This minimally invasive technique involves making a small incision at the site of a compression fracture, followed by the injection of a special cementlike mixture called polymethylmethacrylate into the fractured vertebra. The compound fills the cracks and crevices in the bone, and takes about 20 minutes to harden. Although results from early studies were encouraging, two randomized controlled trials of vertebroplasty found that it worked no better than a “sham” procedure (sometimes called placebo surgery). As a result, the American Academy of Orthopaedic Surgeons recommended against vertebroplasty in guidelines released in 2010.

This procedure is very similar to vertebroplasty, except it involves additional enhancements that yield greater therapeutic results. Mild sedation is usually administered, after which the doctor inserts a thin, tubelike instrument into the affected vertebra, using a fluoroscope to guide its positioning. When the tube is in place, a small balloon at the end of it is inflated, which creates a larger hollow space. The balloon is then deflated and removed, and polymethylmethacrylate is injected.

This offers several advantages over simple vertebroplasty. For one, the creation of the cavity by the expanded balloon helps to restore the natural, larger shape of the vertebra and reduces spinal deformity—while restoring some of the person’s height that was lost from the compression fracture. The cavity also serves as a designated repository for the cement, reducing the risk of leakage into the wrong places. An overnight hospital stay may be required, as the procedure is more involved than vertebroplasty. Like vertebroplasty, therapeutic results for kyphoplasty have been good, but again, more good-quality clinical trials are very much needed before any clear and definitive recommendations can be made.