Houston Methodist. Leading Medicine

Upper Spine FAQ

Question:

I'm just doing a little checking for myself about treatments for vertebral compression fractures. Even though I'm active and not a little old lady, I'm 82 and I've had two of these fractures. The first one I let go and didn't have treated. I regretted that. The second one they did a kyphoplasty but there were complications. If I get another one, what's a better way to go -- or is there one?

Answer:

Efforts to treat vertebral compression fractures (VCFs) with kyphoplasty have met with some problems and complications. It sounds like you might have run into some of these. For those who don't know, kyphoplasty involves inserting a deflated balloon into the fractured and collapsed vertebral body. Hydraulic pressure is used to inflate the balloon. The balloon is then collapsed and removed. The empty space left by the inflated balloon is quickly filled in with a cement that is injected into the area. Researchers are recognizing that more and more patients are not good candidates for the kyphoplasty procedure. Experiments with human cadavers (bodies preserved after death for study) are underway. This is the first step in the investigational process. One of those studies created vertebral compression fractures, and then treated them three different ways. All vertebral bodies from the thoracic spine (T4) to the lumbar spine (down to and including L5) were used. The first treatment was with kyphoplasty -- just the way a patient would be treated with this technique. The second treatment was with a titanium mesh implant cemented in place. The implant looks like a diamond-shaped Chinese finger trap with the center expanded out on each side. The collapsed mesh implants are inserted into a channel or pathway drilled into the vertebral body. A special machine is used to expand the device. The third treatment was with the same titanium mesh implant but without cement. Fluoroscopy, a special 3-D moving X-ray was used to guide implantation in all three treatment methods. Results were measured by calculating the stiffness of the vertebral bodies and the mechanical load they could withstand. These values were then compared to normal, intact, healthy bone. Subgroups that were compared included males versus females and thoracic (midspine) versus lumbar (low back) vertebral fractures. They found that the titanium mesh implants most closely approximated normal bone strength, function, and stiffness. The authors concluded that titanium mesh implants may provide a safe and effective alternative to kyphoplasty for the treatment of vertebral body compression fractures. Cement isn't really needed, so leaving that out can reduce some of the more typical complications associated with kyphoplasty. The results of this study are considered preliminary -- too early to make firm recommendations. Further study is needed to test the abilities and limits of titanium mesh implants. At first glance, these devices appear to provide a protective mechanical scaffold when placed inside the vertebral bones. But the long-term effects have not been calculated or compared against kyphoplasty. Hossein Ghofrani, MD, et al. An Evaluation of Fracture Stabilization Comparing Kyphoplasty and Titanium Mesh Repair Techniques for Vertebral Compression Fractures. Is Bone Cement Really Necessary? In Spine. July 15, 2010. Vol. 35. No. 16. Pp. E768-E773.

*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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