Vertebral Compression Fracture

A vertebral compression fracture (VCF) occurs when a vertebra, one of 33 building blocks of the spine, collapses. Most VCFs occur in the lower thoracic spine or lumbar spine. They are often caused by a fall. In patients with severe osteoporosis, VCFs can occur with bending, coughing, sneezing, or going over a speed bump. Symptoms can range from short-lived mild back pain to severe debilitating back pain. In the latter category, VCFs can lead to decreased quality of life with immobility, accelerated bone density loss, deconditioning, and narcotics (opioid medication) dependence. 

Who is at risk for vertebral compression fractures?

Osteoporosis, thinning of the bone, is the single most important risk factor for developing VCF. In fact, about a quarter of post-menopausal women have VCFs. By age 80, two out of five women have had one or more VCFs. Once you have one osteoporotic VCF, there is a 20% chance that you will develop another VCF in the following year if osteoporosis is not treated.

Spinal tumors — metastasis, multiple myeloma, and intraosseous hemangioma — can also lead to VCFs. Though, this is much less common than osteoporotic VCFs.

What are the treatment options? What is the prognosis?

For most patients, VCFs heal on their own in 4-6 weeks and the pain goes away. The only treatment required for these patients is bed rest and over-the-counter pain medications. Physical therapy and aquatic therapy can also be helpful.

However, for a sizable minority of patients, VCFs do not heal properly and the pain can persist for 3-6 months or longer. The pain can be debilitating, especially with movements, preventing patients from carrying out their normal activities. Some patients are essentially bed-bound and requiring narcotics (opioid medications) to keep the pain tolerable. For these patients, kyphoplasty is a very effective treatment.

What is kyphoplasty?

Kyphoplasty is a minimally invasive procedure done under moderate (“twilight”) sedation where we create a cavity in the vertebral body then deliver bone cement to fortify the fractured vertebra. Almost all of our patients have severe back pain (≥ 6/10) requiring narcotics for pain relief, about a third needs to be hospitalized for pain control. In carefully selected patients, about 90% would get significant pain relief after kyphoplasty. Most are able to get off narcotics after kyphoplasty and resume a normal life. It can also save lives. One recent analysis of medicare patients showed that kyphoplasty significantly reduces mortality rate compared with non-operative management. This study also demonstrated that vertebroplasty — a similar procedure where cement is delivered without cavity creation — also lowers mortality rate, though to a lesser degree compared to kyphoplasty.

Am I a candidate for Kyphoplasty?

Consider consultation for kyphoplasty if you experience the following:

  • Back pain following a fall or minor injury that does not go away after 2 weeks
  • Back pain that wraps around the chest or abdomen (axial back pain)
  • Severe pain (≥ 6/10) limiting ability to carry out normal activities of daily living
  • Pain requiring narcotics use

You will be assessed by our advanced practitioners in our clinic. In addition to clinical assessment, we also obtain an MRI or bone scan to determine if kyphoplasty is indicated. In the absence of bone bruise (marrow edema) on MRI or activity on bone scan, kyphoplasty is not effective and, therefore, is not recommended.

How should I prepare for kyphoplasty?

It is important to tell the doctor about allergies and medications that you are currently taking. Certain types of medications such as blood thinners may need to be stopped for a short time prior to the procedure. You will also not be able to eat or drink anything for a few hours before the treatment except for sips of water to take medication. Wear comfortable clothing and be sure to bring someone to drive you home as you will be discharged the day of the procedure.

What can I expect from Kyphoplasty?

Kyphoplasty is an outpatient procedure performed at Novant Health Presbyterian Medical Center. You will meet with the physician prior to the procedure to review the plan and answer any questions you may have. IV sedation will be administered before and during the procedure to help keep you relaxed and comfortable. The physician will insert a needle through your skin into the fractured vertebra under X-Ray guidance. Cement will be delivered into the fracture and then the needle will be removed. A bandage will be placed on the skin but no stitches are required. The procedure usually takes about 30-45 minutes unless there are multiple fractures that require treatment. You will then be observed in the recovery room for 2 hours prior to discharge home.

What to expect after kyphoplasty.

Our goal is to get our patients off narcotics and help them return to normal life. The majority of our patients experience immediate pain relief after kyphoplasty. In some patients, full relief may take up to 2 weeks. Most patients no longer need narcotics after kyphoplasty. A small minority of patients (about 10%) get little to no relief from kyphoplasty. For these patients, we would consider alternative therapies such as gray ramus communicans injections.
We will work with your primary care doctor to evaluate you for osteoporosis. If you are diagnosed with osteoporosis, we will refer you to a specialist to initiate osteoporosis treatment, which can reduce the risk of recurrent VCF by more than 50%.

Why MRA & Novant Health Presbyterian Medical Center?

Our fellowship-trained interventional neuroradiologists have extensive experience with minimally invasive spinal interventions and have one of the busiest kyphoplasty practices in the region. We perform all our kyphoplasties in a state-of-the-art biplane interventional suite at NOVANT Presbyterian Medical Center where we can offer safe interventions even in the most complex cases.