Kyphoplasty - A Minimally Invasive Approach to the Treatment of Vertebral Compression Fractures.
Last updated Wednesday, February 09, 2005
Fracture - Vertebral compression fractures (VCF) are injuries to the spinal bones. These are equivalent to a break of the wrist bone(s), but occur through the vertebral body of a spinal bone. Bone density - Normal Bone -- Osteoporotic Bone Stabilizing the injured vertebral body - insertion of a type of bone filler (methylmethacrylate cement) into the vertebral body Review of the conditionWhat are some general characteristics of vertebral compression fractures? What are its usual manifestations? Vertebral compression fractures (VCF) are injuries to the spinal
bones. These are equivalent to a break of the wrist bone(s), but occur
through the vertebral body of a spinal bone (See Figure).
These fractures, most commonly, result from osteoporosis or other
processes which cause osteoporosis. Osteoporosis is a condition which
results in decreased bone mineral density, and as a result, weakened
bones.
Conditions which often lead to osteoporosis include estrogen
deficiency (from menopause or premature onset of menopause), multiple
myeloma (a blood cancer which can affect the spine), radiation therapy,
and simply the natural aging process. Because a patient’s skeletal
system is weakened either due to the primary disease process or as a
result of treatment of such diseases, such an individual’s bones are
more prone to fracture. Common sites osteoporotic fracture (breaks)
include the spine, hip, and wrist.
Vertebral compression fractures involve only the anterior column of
the spine. The spine is divided into three columns for classification
of spinal fractures to help guide in the treatment of the different
fractures which can occur (See Figure).
Kyphoplasty is only recommended in the treatment of fractures of the
anterior column of the spine (VCFs). Other fracture types which affect
the spine result in a greater degree of spinal instability, more severe
spinal deformity, and a higher risk of neurologic deficit
(abnormality). Consequently, the risks associated with the utilization
of kyphoplasty in such circumstances usually outweigh the benefits of
the procedure and is therefore considered inappropriate. What are the different types of vertebral compression fractures? VCFs are not fractures without consequence. These spinal fractures
can result in tremendous back pain both in the short and long term.
Because the injured vertebrae is compressed or loses height, a
deformity of that particular vertebrae and the spine as a whole often
results (kyphosis). This deformity, in and of itself, can produce pain
long after the VCF, itself, has healed.
Such kyphotic deformity can lead to additional problems, such, as in
increased risk of adjacent level fractures, abnormalities of the chest
cavity which can result in shortness of breath, ambulatory impairments,
and difficulties with sleep. Other attempts at conservative,
nonoperative treatment of VCFs often are ineffective in preventing
these adverse consequences. Kyphoplasty, on the other hand, attempts to
return patients to their previous levels of function, decrease the time
of functional impairment, and prevent the detrimental long term
consequences of VCFs. This is done by stabilizing the injured vertebral
body through insertion of a type of bone filler (methylmethacrylate
cement) into the vertebral body after the bones height has been
restored through inflation of a balloon like tamp which elevates the
compressed vertebral endplates (See Figure).
VCFs are extremely common fractures. In fact, they are the most
common osteoporotic fracture to occur. Over 700,000 VCFs occur yearly.
Following the first occurrence of a VCF, there is a fivefold or five
times more likely risk of a second VCF. Many patients (approximately
260,000) do not respond favorably to medical treatment. Patients either
cannot tolerate the bracing required, or have adverse reactions to the
prescribed narcotic medication, have a prolonged period of disability,
or suffer from the adverse long term consequences of VCFs. Other
problems which can be associated with VCFs include impaired mobility,
decreased appetite, low self esteem, diminished social interaction, and
loss of independence. Impaired mobility, per se, leads to additional
bone loss and a worsening degree of osteoporosis. The decrease in
appetite can occur as a result of the spinal deformity (kyphosis) which
can leads to compression of the abdominal contents. An individual’s
independence can be affected due to all of the above mentioned
consequences of VCFs, which for the most part, result from the spinal
deformity which commonly results form such fractures. How common is vertebral compression fractures (statistics, demographics, risk factors)? Risk factors for such VCFs include female gender, Caucasian race, early
menopause, advanced age, radiation therapy, sedentary lifestyle,
inadequate calcium intake, hyperthyroidism, hyperparathyroidism,
corticosteroid use, many cancer therapies, organ transplantation,
alcoholism, smoking, and eastern European decent to name only a few.
Males, similarly, are at risk. The risk, however, is somewhat less
because males usually have a higher bone density to start out with and
typically are subjected to more strenuous weight-bearing activities of
daily living. But, females are becoming more and more active,
consequently, the differences in risk are becoming less apparent. Other
medications besides corticosteroids (Prednisone) accelerate
osteoporosis (Dilantin). Effective therapies to prevent osteoporosis
include regular aerobic exercise, calcium supplementation (with Vitamin
D), hormonal replacement therapies, activity modification, and
bisphosphonate medical therapy.
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