As we age, a common problem, especially for women, is osteoporosis – the thinning and weakening of bones. One of the many problems caused by this dangerous condition is stress fractures of the spine, also known as wedge fractures, burst fractures, collapsed vertebrae, and broken back. As the body ages, the square vertebral body of the spine can weaken or be injured with excessive force. It may break and flatten like a pancake, causing back pain and misery. Osteoporosis is the major cause of vertebral body compression fractures; other less common causes include severe trauma, infection or cancer.
Pain is the most common complaint from spine fractures. Any movement causes micro-motion in the broken bone, which produces severe pain. This pain usually decreases when the patient lies down, and increases with standing, walking and lifting. Sometimes people have no pain at all. Rarely fractures may cause numbness, weakness, paralysis or bowel and bladder dysfunction from spinal cord or nerve compression. Fortunately, the severe back pain often improves during the first month after injury.
X-ray, CT, bone scan and MRI may diagnose spinal fractures. Besides diagnosing the fracture, MRI scans can determine if the fracture is new and rule out nerve or spinal cord compression.
Is there a surgical treatment for spine fractures?
Patients who do not respond to conservative treatment may benefit from surgical treatment. The key to surgical treatment is stabilizing the fracture. The spine, like a broken arm, must be “cast” to stop abnormal bone movement and prevent pain. Surgical options include vertebroplasty, kyphoplasty and major spine surgery. Major spine surgery is not commonly needed to treat osteoporotic compression fractures.
Vertebroplasty and kyphoplasty are the most common treatment for osteoporotic compression fractures. These procedures involve the placement of a needle into the fractured vertebral body for the injection of liquid cement. Once the liquid cement hardens it stabilizes the vertebral body decreasing painful movements. If there is concern for cancer then a bone biopsy is sent to pathology for examination.
Vertebroplasty is an outpatient procedure, done under conscious sedation like a colonoscopy, but can be done under local anesthesia in high-risk patients or rarely general anesthesia. A needle is placed into the fractured vertebral body under x-ray guidance and then liquid plastic is slowly injected to harden and stabilize the fracture.
Kyphoplasty is similar to vertebroplasty, but kyphoplasty involves the placement of two needles on each side of the spine and balloons into the broken vertebra under x-ray. The balloons are slowly inflated to expand the collapsed “pancake” vertebral body and create cavities to hold the plastic. Plastic is then injected after the balloons are removed to support and stabilize the broken vertebrae.
Women who developed vertebral body compression fractures are at least four times higher risk of developing future spine fractures. Elderly patients with bone fractures should undergo investigation and treatment for osteoporosis.