Vertebral Fractures

Treatment FAQ's

• What is a spinal fracture?
  

• Are spinal fractures difficult to diagnose?
  

• Why should I be concerned about spinal fractures?
  

• What are the symptoms of a spinal fracture?
  

• Can spinal fractures affect my overall health?
  

• What are the psychosocial effects of spinal fractures?
  

• What is osteoporosis?
  

• Who is at risk for an osteoporosis-related fracture?
  

• Is osteoporosis preventable?
  

• What are the risk factors for osteoporosis?
  

• How common is osteoporosis?
  

• How have spinal fractures been treated in the past?
  

• How long does kyphoplasty/vertebroplasty take?
  

• What type of anesthesia is used?
  

• What are the potential benefits of kyphoplasty/vertebroplasty?
  

• Are there risks associated with kyphoplasty/vertebroplasty?
  

• What can a patient reasonably expect after having kyphoplasty/vertebroplasty?
  

• Can a spinal fracture that occurred a long time ago be treated with kyphoplasty/vertebroplasty?
  

• What type of doctor can be trained to perform kyphoplasty/vertebroplasty?
  

Treatment

Copyright © 2008, Joel Garris MD, FACR. All rights reserved.

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Q: What is a spinal fracture?

A: Fractures of the bones that make up the spinal column are called spinal fractures or vertebral compression fractures. Mistakenly considered a ''normal'' part of aging, the stooped posture that occurs with multiple fractures contributes to chronic pain, reduced quality of life and an increased risk for more fractures.

Q: Are spinal fractures difficult to diagnose?

A: Not really, although they do tend to be under-recognized by physicians and patients alike. About two-thirds of all osteoporosis-related spinal fractures are not diagnosed primarily because:

• Patients with spinal fractures may have mild, or very little discomfort
  

• Patients may consider back pain a normal part of aging
  

• Patients and physicians may not realize the importance of obtaining a proper diagnosis
  

• A complete physical exam, together with an X-ray and/or Magnetic Resonance Imaging (MRI), can help your physician differentiate between pain caused by a spinal fracture or pain caused by other disorders.
  

Q: Why should I be concerned about spinal fractures?

A: After just one spinal fracture, your risk for having another fracture is 3-5 times greater than before because the broken bone affects the distribution of weight along the spinal column. Misalignment brought on by a fractured vertebral body places more stress on adjacent vertebrae; the front of the spine is forced to withstand more stress or weight with fewer functioning parts, resulting in a structure that is now weakened and more vulnerable to additional fracture.

Q: What are the symptoms of a spinal fracture?

A: Most spinal fractures have a gradual onset unrelated to specific injury. Fractures can occur as a result of normal activity; i.e., bending over or reaching for something. In some cases, patients experience sudden and severe back pain without engaging in activity at all. The fact that a spinal fracture can be easily confused with other back problems underscores the importance of obtaining a correct diagnosis and receiving treatment. Complicating the issue of spinal fracture diagnosis is the fact that patients can have pain from a fracture and the fracture may not show up on X-ray for several weeks. If your doctor does not find a fracture on the initial X-ray, but you have persistent back pain with no clear cause, consider asking for a second X-ray. Sometimes an MRI may be appropriate.

Q: Can spinal fractures affect my overall health?

A: Multiple spinal fractures can cause a forward curvature of the spine (kyphosis). This increases your risk for future fracture and can reduce your quality of life. With each additional fracture, the spinal curvature can become more pronounced, painful and debilitating. Severe kyphosis has a "compression effect" on your organs, making it progressively difficult to breathe, walk, eat or sleep. Lung capacity is reduced and mobility can become limited. Early satiety (a feeling of fullness after having eaten only a small amount) can cause you to lose weight and become malnourished. Finally, sleep disorders are common with pronounced kyphosis.

Q: What are the psychosocial effects of spinal fractures?

A: In addition to medical complications, patients with spinal fractures can experience depression, anxiety and lowered self-esteem. The alterations in lifestyle that accompany severe kyphosis can profoundly affect well-being and cause feelings of isolation and sadness.

Q: What is osteoporosis?

A: Osteoporosis is a disease in which bones become fragile and weak, causing them to break more easily than normal bone. Often referred to as the “silent thief”, osteoporosis usually progresses without obvious signs or symptoms until the first fracture occurs. According to a large-scale epidemiologic follow-up study, approximately 1.4 million vertebral fractures due to osteoporosis occur annually in Europe.

Q: Who is at risk for an osteoporosis-related fracture?

A: The International Osteoporosis Foundation estimates that 40% of women and 15% of men over the age of 50 will have one or more osteoporosis-related fractures in their lifetime; however, changes that weaken bone in women can begin as early as age 30. Additionally, long-term use of medications such as corticosteroids can weaken bone.

Q: What are the risk factors for osteoporosis ?

A: The International Osteoporosis Foundation has identified the following as risk factors for osteoporosis:

• Family history of osteoporosis or fractures (in a close relative)
  

• Broken bone after age 50
  

• Height loss of more than 3 cm (just over 1 inch) in adulthood
  

• Low calcium in diet
  

• Smoking, excessive alcohol consumption or taking certain medications (e.g. glucocorticoids)
  

• Normal or early menopause (before age 45)
  

• Low testosterone in men
  

Q: How common is osteoporosis?

A: One in three women and one in five men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime. The International Osteoporosis Foundation cites osteoporosis as a major public threat affecting 19 million Europeans (45% of the population aged 50 and older). 

Back Pain and Spinal Fractures

Q: How does “normal” back pain compare with the pain of a spinal fracture?

A: There are many potential sources of non-fracture related back pain. Sudden, severe back pain, unrelated to specific injury, may indicate that a spinal fracture has occurred. Regardless of the intensity of back pain, it’s never wise to self-diagnose. Patients experiencing back pain should go to their doctor for a physical exam.

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Q: What can happen if a spinal fracture isn’t diagnosed and treated?

A: Left untreated, one fracture can lead to another, resulting in kyphosis (curvature of the spine) and an overall decline in health. Kyphotic deformity and progressive bone weakness increase your risk for additional fractures and can adversely affect your ability to breathe, walk, eat or sleep. Consult with your physician to determine your condition and the appropriate treatment.

Q: How have spinal fractures been treated in the past?

A: Traditional treatment for spinal fractures includes extended bedrest, pain medication and back braces. These treatments can reduce pain, but do not stabilize the fracture or correct the related spinal deformity.

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Q: How long does balloon kyphoplasty/vertebroplasty take? What type of anesthesia is used?

A: On average, the procedure takes about one hour per fracture treated and may be done on an inpatient or outpatient basis, depending on medical necessity. The procedure can be done under local or general anesthesia; the physician will recommend the most appropriate sedation based on the patient’s general condition. After the procedure, the doctor will most likely schedule a follow-up visit and explain limitations, if any, on physical activity.

Q: What are the potential benefits of balloon kyphoplasty/vertebroplasty?

A: Balloon kyphoplasty//vertebroplasty has been shown to achieve restoration of vertebral body height and correction of spinal deformity.

Additional benefits include:

• Significant and sustained reduction in back pain
  

• Significant and sustained improvement in quality of life and ability to perform activities of daily living [17,19]
  

• Significant and sustained improvement in mobility
  

• Significant reduction in number of days per month that a patient remains in bed due to back pain
  

• Significant and sustained reduction in number of days per month when pain interferes with such daily activities as walking, hobbies and work
  

• Sustained vertebral body height restoration
  

• Favorable patient outcomes have been shown to last through two-year follow-up. Studies that document benefits beyond two-year follow-up have not yet been reported.
  

Q: Are there risks associated with balloon kyphoplasty/vertebroplasty?

A: As with any surgery, there are potential risks. Although balloon kyphoplasty//vertebroplasty is designed to minimize these risks as much as possible, there is a chance that complications could occur. Serious adverse events can occur, including but are extremely rare:

• myocardial infarction (heart attack)
  

• cerebrovascular accident (stroke)
  

• pulmonary embolism (cement leakage that migrates to the lungs)
  

• cardiac arrest (heart stops beating)
  

• paralysis or muscle weakness
  

• death
  

Patients should consult with their doctor for a full discussion of risks.

Q: What can a patient reasonably expect after undergoing  kyphoplasty/vertebroplasty?

A: Published studies report a marked reduction in pain, sometimes within hours of the procedure. Balloon kyphoplasty has been shown to improve mobility and enable patients to return to everyday activities such as walking, bending, and lifting, with significantly less pain than they had prior to the procedure. Patients report improved mental health, vitality, social function and emotional well-being.

Q: Can a spinal fracture that occurred a long time ago be treated with  kyphoplasty/vertebroplasty?

A: Age of a spinal fracture and treatment success varies from patient to patient; however, physicians generally agree that the earlier a fracture is treated, the better the chances for deformity correction.

Q: What type of doctor can be trained to perform kyphoplasty/vertebroplasty?

A: Interventional radiologists have had the most extensive experience with these procedures. 

Watch an animation of a balloon kyphoplasty

INTERVENTIONAL RADIOLOGY

               Minimally Invasive Alternatives to Surgery