Houston Methodist. Leading Medicine

Upper Spine FAQ

Question:

I had a vertebroplasty procedure done about two years ago for a spinal fracture from osteoporosis. Now I'm hearing they aren't recommending this anymore. It worked for me -- is this rumor really true?

Answer:

The American Academy of Orthopaedic Surgeons (AAOS) has just released Clinical Practice Guidelines (CPGs) for the treatment of symptomatic (painful) spinal compression fractures. These guidelines are based on research, published studies, and the resulting evidence currently available. The AAOS points out that all guidelines are intended to be used as one tool in the treatment decision. All patient characteristics and individual factors must be taken into consideration when making the final decision. They do review surgical procedures including the vertebroplasty you had. Here's what they had to say. There is moderate support for acute fractures to be treated in the first four weeks with medications (calcitonin). Calcitonin is a non-sex, non-steroid hormone. Calcitonin binds to osteoclasts (the bone cells that reabsorb bone). It decreases osteoclast numbers and activity levels. The end result is that it prevents bone from melting away. It doesn't build up missing bone but it at least keeps the bone that's there from being broken down and reabsorbed. Calcitonin is available in a nasal spray and should be used for osteoporotic spinal fractures within five days of the injury. Calcitonin has been shown to relieve pain when tested in four different positions (e.g., in bed, sitting, standing, and walking). All other treatment recommendations (e.g., bed rest, use of complementary and alternative medicine, narcotics for pain) are not supported by enough evidence to make a strong case for or against them. The evidence is said to be weak or inconclusive. Likewise, evidence for the use of electrical stimulation to encourage bone growth is inconclusive. Evidence regarding minimally invasive surgical procedures such as vertebroplasty and kyphoplasty was also reviewed. Minimally invasive means the incisions used are very small, and there is little disturbance of the muscles and bones where the procedure is done. These two procedures help the fracture heal without the problems associated with more involved surgeries. Vertebroplasty helps reduce pain and strengthens the fractured bone, thus enabling patients to rehabilitate faster. A needle is inserted into the collapsed vertebra and a bone cement is injected into the main body of the vertebra. This fixes the bone so that it does not collapse any further as it heals. More than 80 percent of patients get immediate pain relief with this procedure. Kyphoplasty is another way for surgeons to treat vertebral compression fractures. Like vertebroplasty, this procedure halts severe pain and strengthens the fractured bone. However, it also gives the advantage of improving some or all of the lost height in the vertebral body, helping prevent kyphosis. Needles are inserted through the sides of the spinal column into the fractured vertebral body. These needles guide the surgeon while drilling two holes into the vertebral body. The surgeon then slides a hollow tube with a deflated balloon on the end through each drill hole. Inflating the balloons restores the height of the vertebral body and corrects the kyphosis deformity. Before the procedure is complete, the surgeon injects bone cement into the hollow space formed by the balloon. This fixes the bone in its corrected size and position. There is strong evidence that vertebroplasty benefits patients with osteoporotic spinal compression fractures who are in pain but not experiencing any neurologic problems. Kyphoplasty as an option is supported but the evidence is still weak and further studies are needed. The treatment of osteoporotic spinal compression fractures will continue to be investigated, discussed, and modified according to research findings and current evidence. Long-term studies including patients like yourself may tell a story all its own that will influence future treatment guidelines. Thanks for reporting your results! Stephen I. Esses, MD, et al. American Academy of Orthopaedic Surgeons Clinical Practice Guideline on The Treatment of Osteoporotic Spinal Compression Fractures. In The Journal of Bone and Joint Surgery. October 19, 2011. Vol. 93A. No. 20. Pp. 1934-1936.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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