Houston Methodist. Leading Medicine

Upper Spine FAQ

Question:

I had a vertebroplasty at T12-L1 for a compression fracture (probably from osteoporosis). Now three months later, I have another one right next to it. Am I just going to keep fracturing one after another of these bones? Is there any way to stop this from happening?

Answer:

Vertebroplasty restores the strength of the fractured bone, thereby reducing pain quickly. More than 80 percent of patients get immediate relief of pain with this procedure. It is a simple procedure that can be done under a local anesthesia. But there can be problems such as damaging nerves nearby, infection, and blood clot formation. One other complication is vertebral fracture after vertebroplasty. Studies show there is a range of frequency for this problem that extends from 12 to 52 per cent. Fifty-two per cent is significantly high. There must be some reason for this happening. To help look for risk factors for vertebral fractures after vertebroplasty, surgeons from the Republic of China took a look back at 166 of their patients who had the vertebroplasty procedure. They analyzed the medical records to look for any common cause(s) that might explain this complication. They found one major risk factor and that was the amount of cement injected into the bone. Too much cement (excess volume) was linked with problems later on down the road. In fact, in 38 per cent of their patients, fracture of another vertebra occurred within three months of the vertebroplasty procedure. Two-thirds of these fractures affected the next level vertebra (called the adjacent vertebra). The remaining one-third were remote fractures (farther away from the vertebra corrected with vertebroplasty). This new understanding of the cause of future vertebral fractures after vertebroplasty comes with some challenges of its own. The higher volume of cement is often needed to correct the fractured and collapsed vertebra. In fact, the more cement is used the better deformity correction is possible. So, it's not just a matter of using less cement. Follow-up care after the vertebroplasty procedure may be an important feature in preventing future fractures. Surgeons often recommend patients wear a protective brace for three months after the injection. Medical treatment with calcium supplementation and medications to reduce bone loss should be started immediately. This approach is designed to help address the underlying problem of weak, brittle bones. Physical therapy is also recommended. The therapist will help get you started on specific exercises known to improve osteoporosis. The therapist will help monitor your level of activity during recovery. You will likely be encouraged to modify activities that put force and load through the spine during the healing and recovery period with gradual increase after that. The physical therapist will address posture and body alignment, two key areas of focus in the treatment of osteoporosis and vertebral bone fractures. Variations in the refracture rate could be linked with different ways patients handle the postoperative period. Although it looks as though cement volume is the only significant risk factor for refracture after vertebroplasty, further study is needed. It's possible that just getting older or having the osteoporosis could be enough to put someone at risk for another fracture. But since some patients do not have any further fractures, further analysis and study of this fracture-free group is needed. And a second feature that deserves further investigation is the fact that two-thirds of the fractures were adjacent, while one-third were remote. It remains unknown whether there is some significance to this finding. Various theories have been suggested. For example, maybe some patients are more active than others. This could put more pressure and load through the vertebrae, thereby increasing the risk of a fracture. It's possible that some patients did not wear the protective brace as prescribed. Brace wearing time and pattern of use could be a significant factor and should be studied further. Since volume of cement seems to be the most significant risk factor, additional studies are also needed to determine the optimal volume of cement to use. Research may be able to uncover the minimum amount of cement needed to restore vertebral height as well as the maximum amount that can be safely used. Coming from a different approach, the authors also suggest measuring the angle of vertebral correction to see if there is an optimal kyphotic angle for vertebroplasties to be maximally successful with minimal complications. Yi-An, MD, et al. Subsequent Vertebral Fracture After Vertebroplasty. In Spine. February 1, 2012. Vol. 37. No. 3. Pp. 179-183.

*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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