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Vertebroplasty and Kyphoplasty of Painful Vertebral Body Fractures

The 33 vertebrae are the bones that make up the spine and help support the weight of the body. When these bones break, it may be the result of osteoporosis — the loss of bone mass that makes bones more brittle; a tumor in the region; or a traumatic injury. Each year in the United States, there will be 700,000 vertebral fractures, most of which occur in the middle (thoracic) and lower (lumbar) regions of the spine. Women are at greater risk of these fractures than men, mostly because they are at greater risk of osteoporosis than men.

Symptoms

Most breaks are compression fractures. These occur when the vertebral body collapses resulting in bone-on-bone contact and a sudden onset of pain. Other neurological symptoms, including weakness and numbness in other parts of the body, may also result, and all the symptoms may worsen with walking. Multiple vertebral compression fractures often occur together; multiple fractures can affect posture, resulting in a back hump, a condition called kyphosis, or more commonly, "widow's hump" .

Diagnosis

Vertebral fractures are assessed with physical examination, x-rays, computed tomography (CT) scans, and magnetic resonance image (MRI) scans. When osteoporosis is suspected, a bone density test also will be conducted. Once the site and extent of the fracture(s) have been determined, doctors will develop a treatment plan, which may include osteoporosis, anti-inflammatory, and pain medications, as well as bed rest and bracing to allow the fracture to heal. Most fractures will stabilize on their own, although patients with osteoporosis do not heal well and remain at risk of additional fractures. In some cases, the fracture will not stabilize on its own, resulting in chronic local pain.

Treatment

Interventional neuroradiologists can offer vertebroplasty or kyphoplasty to treat painful vertebral body fractures. In both techniques, a needle is inserted through the skin and into the vertebral body. For vertebroplasty, an acrylic medical-grade cement, poly-methylmethacrylate, is injected into the collapsed bone. For kyphoplasty, the vertebral body is re-expanded with a balloon before the cement is injected. The cement, which is injected as a liquid, hardens quickly, permanently stabilizing the fracture, alleviating pressure, and preventing further collapse. The injection is x-ray-guided: physicians watch the cement — which is infused with a substance that makes it visible on an x-ray — as they inject it. The procedure is safe, relatively rapid (1 to 3 hours), and 75 to 90 percent of patients will experience an immediate or near-immediate alleviation of pain. In fact, researchers are now considering the preventive use of vertebroplasty in patients at high risk of compression fractures.

It is believed that the procedure may have added benefits in patients with tumors that result in compression fractures. The cement may block or compress the arteries that feed a tumor, which can make the tumor shrink, or there may be a component of the cement that is toxic to tumor cells.

While vertebroplasty and kyphoplasty are becoming the standard of care for painful vertebral compression fractures, the treatment has limitations. It does not entirely restore the original shape of the bone, and is not used in patients with degenerative disc disease or disc herniation. In addition, if the fracture results in compression of the spinal cord or nerves in the area, resulting in weakness or numbness in other parts of the body, these techniques cannot be used. The procedure also will not affect the progression of osteoporosis. Among carefully selected patients, however, the treatment is safe and effective.

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