Spinal Fractures (VCFs) and Treatment Options
A spinal fracture occurs when one of the bones in the spinal column breaks. This type of fracture is also known as a vertebral compression fracture because the bone that breaks (the vertebral body) often cracks and collapses, becoming compressed.
The bones in your spinal column are different than the bones elsewhere in your skeleton. For example, the long bones in your legs are more rigid and dense than the square bones in your spine.
Strong, dense bone enables your legs to withstand rigorous movement. The vertebral bodies, however, are less dense and more “spongy,” to accommodate movements like bending and twisting. Because your vertebral bodies aren’t as strong as the bones in your legs, they can become more vulnerable to fracture.
Certain diseases, such as osteoporosis or cancer, are known to cause loss of bone mass and changes in bone structure, making them brittle and weak. Genetic factors and certain lifestyles, such as a low calcium diet, can also damage bone. Over time, the vertebral bodies can become so weak that normal activities such as bending over or lifting a bag of groceries, can cause a spinal fracture.
You can’t feel the changes in your bones while they are happening. In fact, many people are unaware that there is anything wrong until a fracture occurs.
Although you can’t feel your bones getting weaker, you might feel a spinal fracture when it occurs. Sudden and severe pain, out of proportion to the activity at hand, is a hallmark sign of a spinal fracture.
For most of us, the thought of breaking a bone during normal, non-strenuous activity is difficult to imagine. Many patients mistakenly attribute the pain of a spinal fracture to a muscle strain or "bad back." Further complicating the issue is that spinal fractures often occur with only mild, or even indiscernible, pain.
Symptoms commonly associated with spinal fractures that are caused by osteoporosis or cancer include:
- Sudden onset of back pain, unrelated or out of proportion to activity
- Pain worsens with sitting or standing
- Pain is often relieved by lying down
If you have a spinal fracture that has not been diagnosed or has been treated without surgical intervention, be advised that the bone usually heals in its fractured position. This can alter the shape of your spine. For example, you or someone else may notice that:
- You are shorter than you used to be
- Your spine is curved forward (commonly called a dowager’s hump)
- Your clothing doesn’t fit properly
Kyphosis is the term used to describe a forward curvature of the spine. A dowager’s hump or hunchback is often caused by the collapse of spinal vertebrae.
Just one spinal fracture that remains deformed shortens the spine and pushes it forward, adversely affecting spinal alignment. Each additional fracture increases the spinal deformity. This change in spinal alignment can compress your internal organs and affect breathing, eating and digestion. Altering your posture in an attempt to compensate for the kyphotic deformity can affect how you walk and strain your back and joints. All of this can cause medical problems seemingly unrelated to your spine.
The adult spine is a column of 33 bones that protects the spinal cord and enables us to stand upright. Each bony segment of the spine is referred to as a vertebra (two or more are called vertebrae).
The spine has five regions containing groups of similar bones, listed from top to bottom: 7 cervical vertebrae in the neck, 12 thoracic vertebrae in the mid-back (each attached to a rib), 5 lumbar vertebrae in the lower back, 5 sacral vertebrae fused together to form one bone in the hip region, and 4 coccygeal bones fused together that form our tailbone.
The vertebral bodies in the thoracic and lumbar regions have the greatest risk for fracture due to osteoporosis. Cancer and benign tumors can lead to fracture of the cervical, thoracic and lumbar vertebrae.
Bone metastasis is the spread of cancer from its primary site to the bone. Cancers of the breast, lung and prostate are most likely to spread to the bone, and very often the spine.
Cancer cells produce factors that enhance their growth. These factors often destroy local bone. When areas of destroyed bone can be seen on X-ray, they are called lesions.
Tumors destabilize bone, making it weak and more susceptible to fracture. Cancer cells also stimulate bone destruction, which in turn releases factors that stimulate cancer cell growth.
Cancer cells require nutrients to grow. The rich blood supply in the vertebral body may be the reason that metastatic cancers commonly develop there and over time, spread to the rest of the vertebra(e).
Prostate cancer is common in older men and treatment often includes blocking male sex hormones such as testosterone and androgens released by the adrenal glands. Sex hormones in men, like women, are important in maintaining bone health, and their loss weakens bone.
Prostate cancer cells that metastasize to the spine produce factors that can increase bone, as well as factors that break bone down. This can result in lesions to the spine with areas of abnormally dense bone next to areas of destroyed bone, increasing fracture risk.
Maintaining strong bones is a concern for men battling cancer, because lesions in the spine can cause sudden and severe fractures. Also, many treatments necessary to kill the cancer cells can cause generalized bone loss.
Nonsurgical Treatment for Spinal Compression Fractures
Pain from a spinal compression fracture allowed to heal naturally can last as long as three months. But the pain usually improves significantly in a matter of days or weeks.
The majority of fractures heal with pain medication, reduction in activity, medications to stabilize bone density, and a good back brace to minimize motion during the healing process. Most people return to their everyday activities. Some may need further treatment, such as surgery.
Surgical Treatment for Spinal Compression Fractures
When chronic pain from a spinal compression fracture persists despite rest, activity modification, back bracing, and pain medication, surgery is the next step. Surgical procedures used to treat spinal fractures are:
- Balloon kyphoplasty
- Spinal fusion surgery
Vertebroplasty and Kyphoplasty – These procedures for spinal compression fractures:
- Involve small, minimally invasive incisions, so they require very little healing time.
- Utilize acrylic bone cement that hardens quickly, stabilizing the spinal bone fragments and therefore stabilizing the spine immediately.
- Most patients go home the same day or after one night's hospital stay.
This procedure is effective for relieving pain from spinal compression fractures and helping to stabilize the fracture. During this procedure:
- A needle is inserted into the damaged vertebrae.
- X-rays during the procedure help ensure that it's done with accuracy.
- The doctor injects a bone cement mixture into the fractured vertebrae.
- The cement mixture hardens in about 10 minutes.
- The patient typically goes home the same day or after a one-night hospital stay.
Kyphoplasty (aka balloon kyphoplasty)
This procedure helps correct the bone deformity and relieves the pain associated with spinal compression fractures. During the procedure:
- Through a half inch cut in the back, a tube is inserted into the damaged vertebrae. X-rays help ensure the accuracy of the procedure.
- A thin catheter tube — with a balloon at the tip — is guided into the vertebra.
- The balloon is inflated to create a cavity in which liquid bone cement is injected.
- The balloon is then deflated and removed, and bone cement is injected into the cavity.
- The cement mixture hardens in about 10 minutes.
|1. Fractured Vertebra||2. IBT Insert|
|3. IBT Inflated||4. Filling the Cavity|
|5. Internal Cast|
View video of procedure here – WMV format
Spinal Fusion Surgery
Spinal fusion surgery is sometimes used for spinal compression fractures to eliminate motion between two vertebrae and relieve pain. The procedure connects two or more vertebrae together, holds them in the correct position, and keeps them from moving until they have a chance to grow together, or fuse.
Metal screws are placed through a small tube of bone and into the vertebrae. The screws are attached to metal plates or metal rods that are bolted together in the back of the spine. The hardware holds the vertebrae in place. This stops movement, allowing the vertebrae to fuse. Bone is grafted into the spaces between vertebrae.
The patient's own bone or bone from a bone bank can be used to create a graft. The patient's own bone marrow or blood platelets — or a bio-engineered molecule — can be used to stimulate growth of bone for the procedure.
Recovery from spinal fusion surgery takes longer than with other types of spinal surgery. Patients often have a three- or four-day hospital stay, with a possible stay on a rehabilitation unit. Patients typically wear a brace immediately after surgery. Rehabilitation is often necessary to rebuild strength and functioning. Activity level is gradually increased. Depending on the patient's age and health status, getting back to normal functioning can happen within two months or up to six months later.
There are drawbacks to spinal fusion surgery. It eliminates the natural movement of the two vertebrae, which limits the person's movement. Also, it puts more stress on vertebrae next to the fusion – increasing the chance of fracture in those vertebrae. Even after healing is complete, patients may need to avoid certain lifting and twisting activities to prevent putting excess stress on the spine.
*Excerpts from WebMD and Kyphon.com