Non-surgical Treatment of Vertebral Compression Fractures

Osteoporosis affects more than 30 million Americans. Compression fractures of the vertebra occur in more than 500,000 patients per year. Risk factors include advanced age, low weight, chronic disease, and certain medications such as long-term prednisone use. The current medical therapy for Osteoporosis includes calcium and vitamin supplementation, exercise, and medical therapy with a class of drugs known as biphosphonates (Fosamax for example) which help to restore bone mineral density.

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Risk Factors for Osetoporosis

• Being female, thin, or having a small frame
• Advanced age
• Family History of osteoporosis
• Being Past Menopause
• Long term use of medications such as steroids
• Lack of exercise

In patients suffering from osteoporosis, compression fractures can occur with minimal trauma such as a fall and can even result from bearing one's own weight in severe cases. These fractures are extremely painful, greatly affecting patients' quality of life. In addition, chronic immobility because of pain may result in medical complications such as pneumonia or blood clot formation in the legs.

Traditional management of compression fractures includes pain control with medicines ranging from Tylenol to narcotics (Percocet) as well as stabilization with spinal braces. Unfortunately, many patients continue to suffer from pain as well as problems related to the medicines including constipation, nausea, and a feeling of change in their mental status.

Vertebroplasty is a medical procedure which actually stabilizes the fractured vertebra by introducing a surgical grade cement directly into the fractured bone. Once the fracture is stabilized and not continually compressed, the pain is relieved.

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Important Facts:

Vertebroplasty is safe, with a less than 1 % risk of serious complication. Complications may include:

• Bleeding
• Infection
• Fracture of the vertebra or of a rib
• Leakage of cement into surrounding veins
• Worsened pain
• Paralysis due to cement leaking into the spinal canal

Indications

The primary indication for this procedure is for the treatment of a compression fracture resulting from osteoporosis not responding to conservative medical therapy or when bed rest is considered prohibitively risky (patients over the age of 80). When performed for this reason, Vertebroplasty is covered by Medicare. Vertebroplasty does NOT treat spinal stenosis or herniated discs.

What To Expect

Patients meeting criteria as described above can expect a 90% chance of partial or complete pain relief! Although there may be some pain related to the procedure itself, pain relief should be evident within the first few hours after the exam. As above, the overall major complication rate is less than 1%.

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Vertebroplasty Procedure

Vertebroplasty was first performed in France about 10 years ago to treat vertebra affected by a tumor. In the mid 90's, radiologists at the University of Virginia developed the protocol used as a model for vertebroplasty today. In a widely published series, the overall success rate for pain relief exceeds 90%.

Before undergoing Vertebroplasty, patients are screened for the presence of fractures with x-rays. Whether a single fracture or multiple fractures are present, it is critical to ensure that a fracture being treated is the source of the pain. The two most common methods are either with a Bone Scan or an MRI . A Bone Scan is a test which requires an injection of a tracer taken up by the skeleton. Fractures take up more of the tracer and appear "hot". MRI actually shows swelling of a fractured vertebra. Either test can guide the radiologist to treat the appropriate level and maximize the chance for pain relief.

On the day of the procedure, patients are admitted to the hospital and brought to the radiology department at their scheduled time. Once comfortably positioned, a registered nurse administers intravenous medications which should completely alleviate any discomfort. A sterile surgical scrub of the spinal area is undertaken. The radiologist will numb the skin and back of the vertebra. Using the x-ray machine called a fluoroscope, the radiologist carefully places either one or two needles into the middle of the vertebra being treated. Once in good position, a solution of sterile, surgical grade cement is carefully injected until the fracture is completely filled. The cement sets within minutes. Each vertebra takes about 30 minutes to treat.

After the exam, patients are returned to their room and allowed to rest for three or four hours. Then, pain response is evaluated, usually by getting out of bed and walking down the hall. Patients are nearly always discharged on the day of the procedure with subsequent follow up as needed to further evaluate pain response.

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