Spinal Fracture Treatments

Fracture Treatments:

Typically, the first line of treatment for vertebral compression fractures is conservative therapy (non-surgical), which includes pain medication, calcium and vitamin D supplements, rest (but only for a short time period, as prolonged inactivity can lead to further bone loss), and external bracing. Pain from the spinal fracture can last for several months while healing, but if it heals well with conservative treatment the pain will usually improve significantly within a few days or weeks.

When pain from a vertebral compression fracture persists, surgery may be considered to repair the fracture. The two commonly used procedures for spine fractures from osteoporosis are vertebroplasty and kyphoplasty but in rare instances, where the patient has significant loss of vertebral height, spine fusion surgery may be appropriate. Both vertebroplasty and kyphoplasty have been shown to decrease or eliminate the pain associated with vertebral compression fractures.

Candidates for Vertebroplasty

Patients best suited for vertebroplasty are those with a painful, non-healing vertebral compression fracture, regardless of the age of the fracture (although the procedure is most successful for more recent fractures). Most patients experience these fractures due to underlying osteoporosis, but patients who suffer fractures due to tumors may also be eligible. Patients not considered for vertebroplasty include those who are having pain not related to a vertebral compression fracture, those who have an extensive fracture affecting surrounding structures, or who suffer from an infection in which case the infection would have to be adequately treated first prior to undergoing vertebroplasty.

Vertebroplasty Procedure

Vertebroplasty is a minimally invasive treatment option designed to help reduce or eliminate pain caused by collapsed vertebra. With this procedure, low viscosity cement is injected directly into the collapsed vertebral body under high pressure, with the goal of stabilizing the fracture and relieving the associated pain (caused by spinal bones rubbing together). Vertebroplasty can also help prevent further collapse of the vertebra and thus helps prevent further deformity.

In vertebroplasty:

• The patient is positioned face down (prone), which may improve the overall vertebral alignment as compared to standing if the fracture is relatively acute and unstable.
• A thin needle cannula is placed into the vertebra using X-ray guidance.
• Bone cement is injected under pressure directly into the fractured vertebra.
• Once in position, the cement hardens in about 10 minutes, congealing the fragments of the fractured vertebra and providing immediate stability.

In this vertebral augmentation procedure, the material is placed directly into the fracture site to attempt to stabilize the site. There is no manipulation of the vertebra from within using instruments. The cement injected moves between the fracture fragments and binds them together in the position that they are in.