Treating Vertebral Compression Fractures

by: Joshua A. Hirsch, M.D.

New approaches to managing and treating vertebral compression fractures offer patients relief from severe back pain that so many of them unnecessarily endure. When conservative therapies fail, patients do have options.

Therapies for vertebral compression fractures should be examined closely and action taken quickly; not only because pain relief is available, but also because society pays the price for not addressing the fractures in the early stages. The most recent numbers show hospitals and nursing homes spent $17 billion in one year treating these types of injuries.1

Before detailing the treatment options, let's first look at why vertebral compression fractures occur and how this common condition can impact the lives of so many seniors.

Osteoporosis, A Main Cause
The most common cause of vertebral compression fractures is osteoporosis, a disease that causes bone tissue to deteriorate. According to the National Osteoporosis Foundation, 10 million people-55 percent of them age 50 and older and 8 million of them women-have osteoporosis.1 Another 34 million people are at risk of developing the disease. Most people don't even realize they have osteoporosis until a break occurs. Many patients go undiagnosed, thinking their back pain is just a part of aging.

Vertebral compression fractures impact the lives of approximately 750,000 people each year.1 The injury occurs when porous bone tissue inside the vertebrae breaks and then collapses, which can cause severe pain. It doesn't take much for the spine to break. Sometimes a simple activity, such as bending down or twisting, may lead to a vertebral fracture. Patients should take these symptoms seriously because a single vertebral fracture increases a person's risk of further fractures.

Symptoms and Impact
Women who suffer from vertebral compression fractures lose height and may develop a hunchback appearance, which is sometimes called "dowager's" or "widow's" hump. A fracture puts pressure on the spinal cord and may lead to numbness, tingling or weakness. Day-to-day activities, such as walking to the store or climbing stairs, can be excruciating. Left untreated, individuals may begin avoiding physical activities and interacting with friends, leading to depression. This is sometimes referred to as the "downward spiral" of physical, social, and psychological effects.

Conservative Treatment Options
Usually, patients suffering with vertebral compression fractures are first treated with pain medication, calcium and vitamin D supplements, bed rest, or external bracing. The down side to these therapies is a loss in muscle tone due to inactivity. Recovery time is inevitably delayed.

Percutaneous Vertebroplasty Is An Alternative Treatment
A minimally invasive procedure known as percutaneous vertebroplasty treats painful vertebral compression fractures.3,4 Percutaneous vertebroplasty involves a small puncture through the skin with a biopsy needle. Specially formulated acrylic bone cement is injected into the fractured vertebrae, filling the spaces within the bone. The needle is removed and the cement hardens quickly-strengthening the vertebra and stabilizing the spine, thus stopping the pain and preventing further damage. The procedure is performed under light sedation, and the patient leaves the medical facility the same day.4,5

Patients who undergo percutaneous vertebroplasty typically experience 90 percent or better reduction in pain within 24 hours and increased ability to perform daily activities shortly thereafter.6,7,8 Recent research has demonstrated that percutaneous vertebroplasty can relieve pain from vertebral compression fractures for up to nearly three years postprocedure.8,9

Specialists proficient in performing percutaneous vertebroplasty have a solid background in image guided procedures and include interventional neuroradiologists and radiologists. Other specialists, such as pain management physicians, neurosurgeons and spine surgeons could also perform this procedure.

Ideal Patients for Percutaneous Vertebroplasty
Patients best suited for the procedure are those who experienced a fracture less than two years old. Most patients experience these fractures due to underlying osteoporosis, but patients who suffer fractures due to tumors or trauma may also be eligible.

Patients not considered for the procedure include younger patients such as those who have pain not related to a vertebral compression fracture, experience an extensive fracture of surrounding structures, or suffer from an infection in which case the infection would have to be adequately treated first prior to vertebroplasty.

Complications are rare (less than three percent)2, but risk factors include infection, cement leakage, bleeding, spinal cord compression and paralysis. The procedure is typically covered by Medicare and most private insurance plans.2

Managing and Preventing Future Fractures
The best path for managing and preventing vertebral compression fractures is determined by examining a bone scan, x-ray or MRI (magnetic resonance imaging). A bone density test is recommended for all women over the age of 65 and postmenopausal women younger than 65 who have other risk factors for osteoporosis. X-rays and MRIs are requested once a break occurs.

Conclusion
Hundreds and thousands of people have benefited from percutaneous vertebroplasty since it was first introduced in the U.S. in 1995. With increased awareness about its efficacy, even more people who suffer from vertebral compression fractures will benefit from this proven, safe and pain relief option that improves quality of life.7,10 As with any condition, it is important for patients to consult their physician if they suffer from severe back pain and suspect they might have a fractured vertebrae.

To learn more about vertebral compression fractures, including how percutaneous vertebroplasty works, visit www.fracturerelief.com.

References
1. National Osteoporosis Foundation fast facts page. National Osteoporosis Foundation Web site. Available at http://www.nof.org/osteoporosis/diseasefacts.htm. Accessed March 21, 2005.
2. Do HM. Percutaneous vertebroplasty. Dis Manage Dig. 2004; 8:2-4.
3. Centers for Medicare and Medicaid Services, United States Department of Health & Human Services available at http://www.cms.hhs.gov/paymentsystems/icd9/icd040104.pdf. Accessed May 10, 2005.
4. Agris J, Hussain N, Gailloud P, Murphy K. Meta-analysis comparing the in vivo cement extravasation rates for vertebroplasty and kyphoplasty. Paper presented at the American Society of Spine Radiology; February 15-19, 2004; Miami, Fla.
5. North American Spine Society. Percutaneous vertebral augmentation. Available at http://www.spine.org/articles/NT_Percu_Vert_Aug.cfm. Accessed May 10, 2005.
6. Diamond TH, Champion B, Clark WA. Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med. 2003; 114:257-265.
7. McGraw JK, Lippert JA, Minkus KD, Rami PM, Davis TM, Budzik RF. Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol. 2002;13:883-886.
8. Zoarski GH, Snow P, Olan WJ, et al. Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol. 2002;13:139-148.
9. Legroux-Gerot I, Lormeau C, Boutry N, Cotten A, Duquesnoy B, Cortet B. Long-term follow-up of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Clin Rheumatol. 2004;23:310-317
10. Evans AJ, Jensen ME, Kip KE, et al. Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty-retrospective report of 245 cases. Radiology. 2003;226:366-372.
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Joshua A. Hirsch, M.D., is the director of the Interventional Neuroradiology/Endovascular Neurosurgery department and chief of Minimally Invasive Spine Surgery at Massachusetts General Hospital in Boston, Mass. His clinical interests include minimally invasive treatments for back and leg pain. More information is available at www.fracturerelief.com.