The spine is made up of many bones called vertebrae. The front of each vertebrae is made up of a square shaped vertebral body, disc, and ligaments. The discs act to cushion the vertebrae, but if the vertebral body weakens or is injured by excessive force, it may break and flatten like a pancake, which can cause terrible back pain. Osteoporosis, the condition of having weak thin bones, is the primary cause of vertebral body compression fractures; less common causes include severe trauma, infection or cancer.
Pain is the most common symptom of spine fractures. Even the smallest movement of the patient’s body causes micro-motion in the broken bone, which produces severe pain. The patient’s pain level usually decreases when she is lying down and increases with standing, walking and lifting. Sometimes people have no pain at all. Rarely fractures may cause numbness, weakness, paralysis or bowel and bladder dysfunction from spinal cord or nerve compression. Fortunately, this severe back pain often improves during the first month after injury.
X-ray, CT, bone scan and MRI may diagnose spinal fractures. Besides diagnosing the fracture, MRI scans can determine if the fracture is new, judge its response to treatment, and rule out nerve or spinal cord compression.
How are Osteoporotic Spine Fractures Treated?
Patients who don’t see significant improvement with conservative treatment may benefit from surgical treatment. The key to surgical treatment is stabilizing the fracture. The spine, like a broken arm, must be “cast” to stop abnormal bone movement to prevent pain. Surgical options include vertebroplasty, kyphoplasty and major spine surgery. Major spine surgery is not commonly needed to treat osteoporotic compression fractures.
Vertebroplasty and kyphoplasty are the most common treatments for osteoporotic compression fractures. These procedures involve the placement of a needle into the fractured vertebral body for the injection of liquid cement. Once the liquid cement hardens it stabilizes the vertebral body decreasing painful movements. If there is concern for cancer, then a bone biopsy is sent to pathology for examination.
Vertebroplasty is an outpatient procedure, done under conscious sedation like a colonoscopy, but can be done under local anesthesia in high-risk patients. A needle is placed into the fractured vertebral body under x-ray guidance and then liquid plastic is slowly injected to harden and stabilize the fracture.
Kyphoplasty is similar to vertebroplasty, but kyphoplasty involves the placement of two needles on each side of the spine and balloons into the broken vertebra under x-ray. The balloons are slowly inflated to expand the collapsed “pancake” vertebral body and create cavities to hold the plastic. Plastic is then injected after the balloons are removed to support and stabilize the broken vertebrae.
Some patients report immediate pain relief. The remaining patients generally experience pain relief or a lessening of pain within the next two days. Patients can return to daily life the day after surgery, though they should avoid heavy lifting for at least the first six weeks. Each patient should take their surgeon’s advice about returning to activities, as each patient is different. All patients, but especially women, should speak to their doctor about treating their osteoporosis and preventing further bone loss. Women who develop vertebral body compression fractures are at least 4 times higher risk of developing future spine fractures. Elderly patients with bone fractures should undergo investigation and treatment for osteoporosis.