New Treatment for an Old Problem

As a spine surgeon, I frequently see patients with back pain.  Most of the older patients that I see are told that spine pain is part of the aging process and there is nothing that can be done.  If you are older than 60, your back pain may be coming from small fractures in your spine called compression fractures.

A compression fracture is usually defined as a vertebral bone in the spine that has decreased at least 15% to 20% in height due to fracture. Compression fractures can occur in any area of the spine but most commonly occur in the upper (thoracic spine) and mid back (junction of the thoracic and lumbar spine).  The most common locations are T7, T8, T12, and L1.

Compression fractures can cause severe pain in the location of the fracture and radiating pain to the ribs or to the legs.  If left untreated, compression fractures can lead to thoracic kyphosis (dowager’s hump-forward stooped posture of the spine).  Multiple fractures can cause breathing issues, difficulties with balance, and height loss.

The most common cause of compression fracture is osteoporosis.  Osteoporosis is the most common in the follow groups:

• Race: White and Asian women have the greatest risk.
• Age: The chances are higher for women over 50 and go up with age.
• Weight: Thin women are at higher risk.
• Early menopause:  Women who went through it before age 50 have higher chances of getting osteoporosis.
• Smokers: People who smoke lose bone thickness faster than nonsmokers.

Measuring bone density

Bone density and fracture risk are closely related. The most common way to measure bone density is with a DEXA (dual-energy x-ray absorptiometry) scan. If you are a postmenopausal woman taking an osteoporosis medication, the National Osteoporosis Foundation recommends bone density to be repeated every 2 years (or more frequently, depending on your medical history).

Routine testing of your bone density is very important—even if you know you have postmenopausal osteoporosis and are taking steps to manage it with prescription medication, along with calcium and vitamin D, diet, and exercise.

Imaging

If you are having back pain especially due to trauma, we start with getting an x-ray of the area of the spine that is the most painful.  If the x-ray shows that there is a fracture then we get an MRI of the spine.  On x-ray it is very difficult to tell whether the fracture is new or old.  The MRI will show if there is edema (swelling) in the fractured bone.  The edema in the bone is a sign of a new fracture.

Treatments

If you have a new compression fracture, we always try to treat the problem conservatively.  We may give you medications that help with your pain, modify some of your activities, and give you a brace to wear. Usually compression fractures take about three months to heal.

If the pain is not improved with medications, activity modification or bracing, then we consider performing a kyphoplasty.   

The kyphoplasty is performed in our office under local anesthesia.  A needle with a cannula is inserted into the broken bone under the guidance of x-ray.  The needle is then removed and through the cannula, a balloon is inserted and placed near the fractured area.  The balloon is then inflated under x-ray restoring the height of the compressed vertebral bone.  The balloon is then removed and liquid cement is then placed into the vertebrae.  The liquid cement serves as glue between the fractured parts of the bone.  The body temperature causes the cement to harden and support the fractured bone.  

In most cases, pain relief is immediate.  The procedure takes about 20 minutes to do and patients go home within an hour.  There is no need to wear a brace after the procedure and patients can resume their normal daily activities.  It is one of the most successful procedures.

To learn more about the procedure, or to request an appointment, please contact us at (919) 297-0000 or request an appointment through our website.

Kyphoplasty (Balloon Vertebroplasty)