People with osteoporosis are prone to painful spinal compression fractures. Standard routine care is frequently surgery—either vertebroplasty or kyphoplasty, procedures that literally glue the bones back together. However, which is better…and whether either is any better than more conservative therapies…has not been clear. An international task force of orthopedic specialists now has answers.
Roughly 750,000 US adults suffer from vertebral compression fractures most of which are caused by osteoporosis. In fact, these kinds of fractures are the most common complication of osteoporosis and can result from such simple activities as a minor fall, carrying something heavy or even bending the wrong way. Kyphosis (curving of the spine) and/or loss of height are often used to detect that such a fracture may have occurred. One-third of compression fractures cause acute and chronic back pain.
Unfortunately, there aren’t many treatment options for spinal fractures. Among them are two surgical procedures, where bone cement is injected into the broken vertebrae to stiffen up the bone in the hope that stopping it from moving will reduce or eliminate the pain. Percutaneous vertebroplasty involves injecting bone cement directly into the injured vertebra. Balloon kyphoplasty, a newer procedure, involves inserting a balloon into the crushed vertebra and inflating it to expand the bone to its original shape before injecting the cement.
Because there is no consensus among surgeons as to which procedure is better—nor any agreement as to whether either is better than less invasive approaches—The American Society for Bone and Mineral Research recently created a task force to look into the effectiveness of vertebroplasty and kyphoplasty, as well as other treatments for spinal compression fractures. An international team of researchers looked at 28 studies that addressed the effectiveness of either procedure, as well as other treatments for spinal compression fracture, based on improvement in pain, mobility and/or quality of life.
Results: Compared with placebo (sham surgery without the injecting of the cement) vertebroplasty was no better at improving pain, mobility and quality of life. Kyphoplasty may be marginally better, but the procedure is newer and there were no placebo-controlled trials.
The researchers do not suggest completely ditching vertebroplasty and kyphoplasty for spinal compression fractures. These procedures may still help some people when nothing else does. What the task force recommends is trying more conservative approaches—such as bracing, rehab exercises to strengthen the trunk and offload pressure on the spine, anti-inflammatory drugs and/or painkillers—before going for surgery. In fact, time itself will help your body heal.