There’s an expression among comedians that timing is everything. That same concept can be applied to many things including medical treatment for vertebral compression fractures (VCFs). In this study, surgeons in Korea took a look at the use and timing of kyphoplasty for this type of fracture.
Compression fractures are the most common type of fracture affecting the spine. A compression fracture of a spine bone (vertebra) causes the bone to collapse in height. Compression fractures are commonly the result of osteoporosis (decreased bone density or “brittle bones”).
About 750,000 cases of compression fractures due to osteoporosis occur each year in the United States. Spine bones that are weakened from osteoporosis may become unable to support normal stress and pressure. As a result, something as simple as coughing, twisting, or lifting can cause a vertebra to fracture.
Kyphoplasty to treat the problem involves inserting a deflated balloon into the fractured and collapsed vertebral body. Hydraulic pressure is used to inflate the balloon. The balloon is inflated until the vertebral body height is restored to normal or until the balloon is fully inflated. The balloon is then collapsed and removed. The empty space left by the inflated balloon is quickly filled in with cement that is injected into the area.
The optimal timing for kyphoplasty remains unknown. There isn’t a lot of data yet on the best timing for treatments using this technique. This study compared two groups of women diagnosed with an osteoporotic vertebral compression fracture at one spinal level (between T10 and L2). Everyone in both groups was treated with kyphoplasty. Half the women (a total of 20 adults) were treated within two weeks of the fracture. The other half (group two with the same number of women) had the kyphoplasty procedure at least two weeks after the fracture occurred.
The results were measured and compared before and after treatment using patient perceived level of pain and X-ray analysis of spinal correction/deformity. They found that everyone improved but the early group had measurably better results. Pain levels were reduced equally between the two groups. It was the degree to which the spine could be restored to its natural height that was better in the early-to-surgery group. Spinal alignment was also significantly better in the early-to-surgery group.
Should everyone have a kyphoplasty right away after the fracture occurs? There are some good reasons to make that suggestion but some drawbacks as well. On the “yes” side of things, early treatment reduces pain and the need for pain medications. Function is improved and quality of life is reportedly better.
With a delay in treatment, there is the potential for increased spinal deformity. As the vertebral body collapses further, pressure on the spinal nerve roots creates more pain. The flexed posture of the spine (called kyphosis) shifts the center of gravity forward and puts pressure on the vertebrae above and below the fractured segment. The result can be additional vertebral compression fractures.
One major reason why kyphoplasty gets delayed has to do with insurance. In Korea, the National Health Insurance plan requires bed rest for at least three weeks for spinal fractures. Since studies haven’t proven the need for early intervention with kyphoplasty, the results of this study are especially important for policy change in that country. Associated cost savings from early treatment and return-to-work, social function, or normal activities of daily living are enough to support such a policy change.