Vertebroplasty and Kyphoplasty: Two Options For Vertebral Fractures from Osteoporosis

Health Professional

The most common location for an osteoporosis-related fracture to occur is the vertebrae.

These painful back injuries can occur while engaging in everyday actions, such as bending over or lifting groceries. With very advanced osteoporosis, a sneeze or cough could cause vertebral fracture. In some cases, the breaks are so debilitating routine tasks may be impossible, and the resulting inactivity can open the door for other serious medical problems.

Fortunately, treatment for vertebral fractures is a quickly advancing field, and patients have far more options than they did a decade ago. For many doctors the first step is to prescribe medication. Calcitonin (Miacalcin), a hormone which reduces the breakdown of bone, may help reduce pain.

Narcotic pain relievers are usually not considered because they could increase the chance of a fall, a dangerous prospect for someone with brittle bones. In addition, physicians recommend a back brace, although compliance can be irregular.

In some cases, the pain from the fractures will subside on its own. When extreme discomfort persists, however, and interferes with daily living, more definitive treatment measures may be considered.

In March, researchers in Italy announced that percutaneous vertebroplasty, the oldest and most widely practiced procedure for the stabilization of fractured vertebrae, have overwhelmingly positive results. During this procedure, real-time X-ray guides a doctor to the exact location of the fracture, where he or she uses a needle to inject medical-grade cement through the skin directly into the fracture.

A five-year study tracked 884 patients who had a total of nearly 4,000 fractures repaired. More than 95 percent of patients reported that their pain decreased after the procedure. Reports of poor quality of life dropped from 69 to less than 19 percent.

"Vertebroplasty is safe and it works," Dr. Giovanni Anselmetti, an interventional radiologist at the Institute for Cancer Research and Treatment in Turin, Italy, wrote in an email discussing his research, which he plans to publish later this year. "If the patient has back pain regression usually he could dismiss brace support, he does not need pain-killers anymore, and he is able to do by himself the daily life activities again."

Bone cement is harder than bone itself, and there is some controversy over whether that difference contributes to new adjacent fractures. Subsequent vertebral fractures are common after the first, whether or not a patient undergoes vertebroplasty, so this remains under discussion among experts.

Another recent study has indicated that a repeat vertebroplasty may help if the first one didn't relieve pain.

During kyphoplasty, a balloon pushes the bones back to their proper height before inserting the cement. The goal is to help correct kyphosis, or a hunched back. A number of studies have indicated that vertebroplasty and kyphoplasty are comparable to one another in terms of potential benefits and adverse effects.

Some physicians prefer to use kyphoplasty on newer fractures and employ vertebroplasty when more time has passed since the injury, but such decisions vary from one doctor to another and the circumstances of each particular case.

Note: Kyphoplasty is considerably more expensive, frequently running over $3,400, while vertebroplasty can often be performed for less than $600.

"There is no data showing one is safer than the other," says Dr. Michael J. DePalma, an interventional spine physiatrist who performs both types of procedures and is Medical Director of the Virginia Commonwealth University Spine Center. "Both are equally effective."

Vertebroplasty and kyphoplasty each have some potential for rare negative outcomes. Both are generally conducted under light sedation, which has fewer risks than general anesthesia, but could pose problems for people with conditions such as congestive heart failure. The surgery is not suitable for those who have untreated bleeding problems or an active infection.

Infrequently, the cement has leaked out from the injected site. This could cause compressive injury to a nerve or even paralysis if the spinal cord is affected. Often times this problem can be corrected with another operation, but in extremely unusual cases the cement could form a deadly pulmonary embolism. According to Dr. Anselmetti, this occurs only in cases of malpractice in which the doctor did not use the correct imaging system to guide the operation.

Taking no action regarding the osteoporosis responsible for fractures can also pose a threat to health. According to Dr. DePalma, mortality with spine fractures is even higher than for hip fractures.

They can significantly reduce one's quality of life and the ability to care for oneself, and even contribute to other, even more serious fractures. For these reasons, those who have vertebral fractures may want to discuss with their physicians if they may be good candidates for taking prescription osteoporosis medication.

For example, synthetic parathyroid hormone, sold under the brand name Forteo, may be used for up to two years by patients with severe osteoporosis to help build bone mass.

Another option includes a class of drugs known as bisphosphonates - such as Fosamax, Boniva, Actonel, and Reclast - which can prevent fractures by reducing the body's natural breakdown of bone. Since all medicines have the potential for side effects, consult with your doctor carefully as to whether taking an osteoporosis drug is right for you.

With proper medical treatment, there may be no need to endure perpetual back pain caused by osteoporotic vertebral fractures.