FAQ’s on Vertebral Compression Fractures
Vertebral compression fractures (VCF) occur when one or more spinal vertebrae sustain a compression force beyond what the bone can withstand, thus fracturing the bones or causing collapse. Typically this occurs in patients who have had one or more other conditions that weaken or traumatize their bones, with the most common causes being osteoporosis, osteogenesis imperfecta, lytic lesions or infection (A nation-wide, outpatient-based survey on the pain, disability, and satisfaction of patients with osteoporoticvertebralcompression fractures 2013)
What are the causes of Vertebral Compression Fractures?
Vertebral compression fractures are the result of the vertebrae being too weak to withstand an outside force, causing them to fracture when the force is applied. An important factor to note is that the force doesn’t have to be excessive. If bones have been weakened enough, even a cough can be enough force to fracture them. In healthy individuals it can come from an extreme vertical shock.
What are the symptoms of Vertebral Compression Fractures?
The primary symptom felt is progressive pain at the level of the fracture, which will vary in severity based on the severity of the fracture. If multiple vertebrae fracture, the spine may shorten as the fracture vertebrae are no longer able to provide support anteriorly, although the pedicles are intact.
How is a Vertebral Compression Fracture diagnosed?
Diagnosis is achieved through an examination of the current symptoms, the events leading up to the presence of symptoms, and diagnostic imaging tests used to examine the vertebrae for damage. The most common being a spinal radiograph. For osteoporosis, bone density measurements may be used for evaluation. If the fracture is from trauma, a CT or MRI scan will be used.
What are the treatment options for Vertebral Compression Fractures?
Medication: Patients with only minor symptoms may be regulated to taking over the counter medications for pain and inflammation. Calcitonin may be helpful with osteoporotic cases.
In cases where pain is more severe, the attending physician may prescribe stronger medication to provide relief (opioids).
Bracing A Jewett brace or in more severe cases, a TLSO, will be used for support while healing occurs.
Physical Therapy: The purpose of physical therapy for a VCF is to restore functionality to the spine while providing pain relief for the patient. This is achieved by resting the spine as much as possible to not worsen the fracture and through the use of warm and cold compresses for local pain and as a tool for the slow return to mobility.
The most common forms of treatment for vertebral compression fractures are invasive options, with primary goals of returning stabilization to the spine to provide relief for symptomatic pains and of restoring movement to the patient. The surgeries used most often in the treatment of vertebral compression fractures are called a Vertebroplasty and a Kyphoplasty.
Kyphoplasty: To begin with, a small incision will be made into the back above the fracture vertebrae. Through this incision, the physician will place a narrow tube into the vertebral fracture with the use of fluoroscopic imaging for guidance. Once positioned, the physician will continue to use fluoroscopic imaging to guide a special balloon into the vertebrae via the tube. Once positioned, this balloon is gently inflated ([Treatment of senile osteoporoticvertebralcompression fractures with percutaneous kyphoplasty under local anesthesia 2013)
The balloon is inflated for two main reasons: To return the fracture to an almost normal state of bone placement, and to form a small cavity inside the vertebrae in preparation for the cement. After the cavity has been made, the balloon will be removed. Specialty cement will be injected at this time under low-pressure, where it will quickly solidify to provide a stable vertebra (Percutaneous balloon kyphoplasty for the treatment of vertebral compression fractures, 2014), (A prospective study of percutaneous balloon kyphoplasty with calcium phosphate cement in traumatic vertebral fractures, 2014).
Vertebroplasty: The procedure begins much the same as a kyphoplasty, but does not feature the inflation of a balloon to create a cavity. Instead, the spinal cement is directly injected into the fractured vertebrae under high-pressure where it will be allowed to solidify to create stable bone (Efficacy and feasibility of vertebroplasty for severe vertebral fracture: a retrospective study of 12 vertebroplasties, 2013)