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Bona Fide Treatment for Spinal Compression Fractures in Patients with Osteoporosis

Posted on: 11/30/1999
More than 24 million Americans suffer from osteoporosis. Osteoporosis results in significant bone loss, making the spine vulnerable to vertebral compression fractures, or VCFs. In patients with osteoporosis, the vertebral body can become fractured from something as simple as coughing, twisting, or lifting.

Round in shape, the vertebral body crumbles into the shape of a wedge. The spine angles forward and becomes hunched in appearance. This is called spinal kyphosis. A severe kyphosis can put pressure on the lungs and digestive system, getting in the way of breathing and appetite.

VCFs can be very painful, creating hardships with daily activities. And VCFs can produce a host of spine problems, such as pressure on the nerves or spinal cord. All of these factors point to a 30 percent higher mortality rate for patients who have VCFs.

Treatment for VCFs often includes bed rest, pain medications, and bracing. But the lack of movement that goes along with these treatments can cause even more bone loss.

In 1987, a nonsurgical treatment called vertebroplasty was introduced. In this procedure, cement is injected into the collapsed vertebral body to strengthen the broken bone. Although it effectively reduces pain, this technique doesn't restore the original height of the vertebrae. Also, the liquid cement is injected under high pressure and commonly leaks into surrounding areas.

This study reports on a new procedure called kyphoplasty. With kyphoplasty, doctors use an instrument that inflates like a balloon to restore the broken vertebra to its original height. The balloon forms a space inside the broken vertebral body. This space is then filled with special bone cement. (The cement is allowed to thicken first, to reduce the chances that it will leak.)

In this study, the kyphoplasty procedure was done on 30 patients. Twenty-four of the patients had tried traditional treatment with no results. The other six had painful VCFs from multiple myeloma, a rare form of cancer affecting cells in the bone marrow. Patients averaged 69 years old. They'd had symptoms for about six months.

After kyphoplasty, nearly all of the patients felt better right away. None felt worse. Questionnaires completed after the procedure showed that patients improved in pain, physical functioning, social functioning, and mental health.

The procedure raised the height of the vertebral body in all cases. In 70 percent of the cases, kyphoplasty restored the vertebra to nearly half its original size. Restoring vertebral height through kyphoplasty is the main advantage over vertebroplasty, which merely fixes the broken bone in place.

During the kyphoplasty procedure, the cement leaked less than 10 percent of the time. When this happened, cement injection was stopped. No problems came from cement leakage afterward.

About seven months later, there were no major complications from the treatment. The authors feel this is a safe, effective treatment for patients with painful VCFs. The procedure seems to give immediate pain relief. It enabled some patients to move around who hadn't been able to before.

Notably, this study followed patients for only a short time. Longer-term follow-up is needed. The procedure also needs to be tested on a larger group of patients. Because patients with VCFs may improve on their own over time, the results should be compared to those of patients who don't have any treatment.

I. H. Lieberman, MD, et al. Initial Outcome and Efficacy of "Kyphoplasty" in the Treatment of Painful Osteoporotic Vertebral Compression Fractures. In Spine. July 15, 2001. Vol. 26. No. 14. Pp. 1631-1638.

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