Dr. Reza Shahim

It is estimated that nearly 800,000 people suffer from painful and often debilitating vertebral compression fracture (VCF) every year in the U.S. VCF is common as people age and is often linked with osteoporosis.

“In osteoporosis, bone mineral density is decreased, which predisposes an individual to VCF,” said Reza Shahim, MD, a board certified neurosurgeon with the Arkansas Surgical Hospital in Little Rock. “The lifetime risk for women is about 16 percent and it is five percent for men. Additional causes of this type of fracture are trauma and tumors of the spine, including metastatic disease.”

If the pain is mild, doctors usually treat patients with rest, bracing and pain medications (NSAIDs, muscle relaxers, and narcotics). For patients with severe pain the best treatment would be vertebroplasty or kyphoplasty.

“These procedures are minimally invasive and can be done as an outpatient,’” Shahim said. “Both procedures are done using a needle and involve injecting PMMA (polymethylmethacrylate) which is a liquid material that solidifies after injection. Success rates for both procedures are 85-90 percent with a less than a five percent complication rate. Most patients will get significant improvement in pain.”

Vertebroplasty stabilizes the collapsed vertebra using PMMA. Kyphoplasty uses a balloon placed in the fracture to reduce kyphosis (curvature or angulation) and restores the height of compressed vertebra. The space created by the balloon is then filled with PMMA. Spinoplasty is similar to kyphoplasty, but a balloon mesh, OptiMesh®, is deployed in the fracture and then it is filled with bone graft.

“The outcomes are similar, but this is a new procedure and long term follow up is not available,” Shakim said. “The physician chooses between these procedures based on personal experience and in part based on the anatomy and type of fracture, but the outcome results are similar.”   
Wayne Bruffett, MD, an orthopedic spine surgeon at St. Vincent Hospital, Little Rock, advocates surgery for VCF only after other options have been exhausted. He starts with observation and pain control giving patients time to heal on their own.

“If the fracture is due solely to osteoporosis, it is a benign process,” he said. “It will usually heal. We don’t need to get too aggressive treating these fractures unless a patient’s quality of life is markedly compromised. Vertebral fractures have healed since beginning of time. One of the most traditional treatments has been a brace. But that can be more ceremonial than functional.”

If the patient doesn’t get better, then he recommends vertebroplasty or kyphoplasty. Both procedures are typically done by a surgeon or a radiologist, but are also done by some pain management physicians and by physiatrists.

“This is a percutaneous procedure where bone cement is delivered to vertebral body, which hardens in five minutes time to fill cracks and crevices of the compression fracture,” Bruffett said. “It tends to work very, very well. There are risks with anesthesia and the risk cement can go somewhere you don’t want it to go like a vein or artery, or spinal canal around the nerves. But that is rare.”

Of the two procedures, he prefers kyphoplasty, but saves that for people who are quite debilitated. Restoring them to functioning can help prevent declines and resulting problems such as bedsores from being confined to bed.

“If you can do a procedure that really helps with their pain and keeps them mobile, it prevents more detriment to their health,” Bruffett said. “It is important to discuss options with patients and see where they are. If they are in miserable pain, not eating, and not getting out of bed, kyphoplasty can be an excellent treatment modality. One of the great things about the procedure is there is not significant aftercare. Once the cement hardens, they can get up and do what they want to do.”

Bruffett would like to see more people taking action early in their life to be proactive about bone health and prevent osteoporotic VCF.

“Really, we need to start when people are kids because you reach your maximum bone density in your early 20s and then things start to decline,” Bruffett said. “Try to have the best bone density starting early in life, and it helps you as you get older. The key involves adequate calcium in the diet from good nutrition. And I’m a big proponent of weight bearing exercise. It is being shown more and more that if you can do some strength training when you are younger through the 40s and 50s, bone health will be better later in life.

“The key for spine health is core strengthening, whether it is through weight lifting, pilates, yoga or whatever. You are building a brace out of your core muscles. When you bend over to lift, your muscles are stronger to stabilize the body. The main thing is to get up and be active doing things. What type of exercise you do isn’t as important as sticking with whatever you like to do.”

Exercise is particularly important for people at the highest risk, which is fair skinned, thin women. The condition is not as common in African Americans and not as common in a heavy-set person because their bones have felt their weight for so long.

“I’m not advocating obesity, but having some meat on the bones has advantages,” Bruffett said. “It is also important for people in their 50s, 60s and 70s to see their primary care physician and talk about family history, risk factors, whether there is a need for a bone density test, and a look at where you are against age matched peers. Your doctor determines if you need therapy. Then get follow-up studies to compare and see where your point is on the graph. If it starts to decline, then do more active treatments for osteoporosis.”

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