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Kyphoplasty and Vertebroplasty: Minimally Invasive Percutaneous Treatment for Osteoporotic Compression Fractures
Last updated Tuesday, December 02, 2008
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Review of the conditionCharacteristics of osteoporotic compression fractures in the spine Patients with osteoporotic compression fractures generally have back pain. After several fractures, a kyphotic or hunched over deformity can be present. Usually the pain will decrease after weeks to months, however it is not uncommon for the pain to persist beyond this time period.Osteoporotic compression fractures occur because of metabolically weakened bone (from osteoporosis). The bone is weakend to the point, that very little force can cause to vertebra to collapse or become crushed.Types Osteoporotic compression fractures occur because of metabolically weakened bone (from osteoporosis). The bone is weakend to the point, that very little force can cause to vertebra to collapse or become crushed.
Compression fractures can also be caused by weakened bone from other non-osteoporotic diseases. Cancer, which spreads to the bone can also weakened the vertebra so that it fractures with little force.
Finally, trauma can cause compression fractures. Usually in these cases, the bone strength and density is normal, but the high energy nature of the trauma (such as a fall from a high height, or a motor vehicle accident) creates the fracture
Similar conditions Back pain can occur from other causes as well. In general compression fractures occur from disease (osteoporosis, cancer) or trauma. There are numerous other causes of back pain. These include degenerative arthritis, infection, disc herniation, and many more. The compression fractures, however can be easily differentiated from these other causes of back pain with a thorough history, physical exam, x-rays, and occasionally advanced imaging, such as a CT scan or an MRI.Incidence and risk factors Vertebral compression fractures can affect up to 20% in patients older than 70 years, and up to 16 % of women after menopause. An estimated 700,000 compression fractures occur annually in the United States.
Diagnosis The diagnosis of osteoporotic compression fractures is usually suspected by a simple history and physical exam. This diagnosis can be confirmed with x-rays of the spine. A CT scan can be used to further evaluate the fracture, and an MRI scan be used to determine if the fracture was a recent event, or if it is an old healed fracture.
Medications In general, oral medications do not make the fracture heal more quickly. Medications help in the treatment of compression fractures in that they can lessen the pain, while the fracture heals. While exercise is beneficial in a number of conditions and for overall health, they do not assist in the healing of osteoporotic compression fractures.
Exercises While exercise is beneficial in a number of conditions and for overall health, they do not assist in the healing of osteoporotic compression fractures.
Possible benefits of kyphoplasty and vertebroplasty Under anesthesia, the fractured vertebra is approached posteriorly (from the backside). Using x-ray in the operating room, a trochar, or a thin tube, is inserted into the fractured bone in the spine through the pedicle.
For vertebroplasty, bone cement is then injected into the fracture.
For kyphoplasty, a balloon is inserted through the trochar and inflated once inside the bone. This balloon inflation restores the natural form of the vertebra. After inflation of the balloon, the bone resembles its pre-fracture shape. After the balloon inflation has been performed, it is removed. Bone cement is then inserted to fill the void that the bone cement created.
The main difference between kyphoplasty and vertebroplasty is the restoration of normal bone shape with kyphoplasty. In vertebroplasty, the bone cement stabilizes the fracture, but does not attempt to reconstitute the normal bone shape. In kyphoplasty, the inflation of the balloon before inserting the cement is intended to restore the bone shape to what it was like before the fracture.
The cement injected into the bone with both vertebroplasty and kyphoplasty, acts to stabilize the fracture. This fracture stabilization usually resolves the pain the patient feels.
Surgery for Osteoporotic Compression Fractures in the Spine at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington If you are interested in making an appointment to discuss this procedure in Seattle, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-598-4288 to make an appointment. Our clinical center is located in Seattle Washington, USA
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