Guide to Advanced Surgery for The Spine
Why Choose Cedars-Sinai Marina del Rey Hospital for Vertebral Compression Fractures?
At Cedars-Sinai Marina del Rey Hospital, our well-trained team of spinal surgeons can manage vertebral compression fractures with either surgical or non-surgical treatment options. The course of treatment prescribed depends on the severity of the spinal trauma and the patient's overall health.
Vertebral compression fractures (VCF) occur when the spinal bones or vertebrae collapse or break down as a result of trauma or disease. VCF often affects the thoracic segment of the spine, particularly the lower portion. VCF is most common in patients with osteoporosis. About 25% of postmenopausal women have been affected by VCF in the United States. VCFs are more common in women than in men. People who have experienced a VCF due to osteoporosis are at five times greater risk of developing a second VCF. There may be mild or no symptoms at all associated with a VCF.
Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital for Vertebral Compression Fractures
Surgical treatment of vertebral compression fractures is considered when a patient has persisting severe pain that cannot be resolved with conservative treatment methods. The two minimally invasive surgical options available for VCF are vertebral augmentation methods, such as kyphoplasty and vertebroplasty. The most suitable method is chosen based on the type of VCF.
- Kyphoplasty: This procedure is done under general anesthesia or after ther administration of local anesthesia that numbs the region surrounding the fracture. During the procedure, the surgeon will make two small incisions, through which a needle will be passed into the broken vertebra under radiographic guidance. Through this needle, a tiny device called a balloon tamp will be inserted into the broken vertebra, which is then inflated in order to restore the height of the vertebral body. The balloon tamp is then withdrawn to leave behind space for a special kind of bone cement, which is filled into the area to strengthen the vertebra.
- Vertebroplasty: This surgical procedure is commonly performed on an outpatient basis, but may sometimes require an overnight stay at the hospital. Under the radiographic guidance, a fine needle filled with special acrylic bone cement is directly injected into the broken vertebra. This cement becomes hard within a few minutes, thereby strengthening and stabilizing the spine.
Patients who undergo minimally invasive surgery for VCF can expect a speedy return to their routine activities.
Drugs and Other Treatment Needed for Vertebral Compression Fractures
In the majority of patients, VCF often resolves within three months without any specific treatment for fracture repair. In these cases, achieving pain relief is important, as it improves mobility and helps to promote comfortable sleep. Taking pain medications and bed rest for a short period of time is sufficient in most VCF cases. A doctor may also advise wearing a brace to control movements and facilitate healing.
Bed Rest »
Back Bracing »
While determining the type of VCF, it is important to note the specific portion of the vertebra that is affected.
Fractures Associated With Physical Injury »
Fractures Associated With Tumors »
Multiple VCF »
Osteoporotic Fracture »
Symptoms of Vertebral Compression Fractures
The symptoms associated with VCFs include:
- Sudden, severe back pain that is often felt near the fracture (in the middle or lower portion of the spine)
- Disabling pain that is often described as “knife-like” or sharp in intensity
- Pain that becomes worse with movements (standing, walking, coughing, sneezing) and decreases when the patient is lying down or resting
Osteoporotic VCFs have no symptoms initially and are often found on spinal X-rays made for some other reason. Gradually, the following symptoms may develop:
- Height loss of about six inches.
- Kyphosis or stooped-over posture often called Dowager’s hump.
Diagnosis of Vertebral Compression Fractures
A careful physical examination and history are often sufficient to diagnose VCF. Imaging tests, such as plain X-rays, computed tomography (CT scan), and magnetic resonance imaging (MRI scan) may also be used to confirm the presence of a VCF.
- CT scan: This imaging test can reveal the content, size, and shape of the spinal canal and the structures surrounding it. To derive additional information, a CT scan may be done along with a myelogram of the spine.
- MRI scan: This imaging test uses powerful magnets and computers to create a three-dimensional image of body structures, such as the spinal cord and nerve roots. It can also capture images of disc degeneration, enlargement, or tumors.
- Dual-energy X-ray Absorptiometry (DEXA) or bone densitometry test: A standard test to measure bone mineral density and diagnose osteoporosis. DEXA is a painless test that involves directing X-rays at a predetermined frequency from two sources towards the bone, resulting in an alternating pattern. Small variations in bone mass can be detected using DEXA, and the procedure can be utilized for both the spine and the extremities.
Risk Factors for Vertebral Compression Fractures
The risk factors associated with VCFs are classified into non-modifiable (uncontrollable) risk factors and potentially modifiable (controllable) risk factors.
Non-modifiable risk factors include:
- Advancing age;
- Gender (VCFs are more common among women)
- Attaining menopause at an early age
- Racial background (VCFs are most common among Caucasian and Asian people)
- A family history of osteoporosis and fractures
- A thin body frame
Potentially modifiable or controllable risk factors include:
Causes of Vertebral Compression Fractures
The three major causes of VCF include:
- Osteoporosis: Osteoporosis is a bone disorder that reduces the strength of bone, making them more brittle and susceptible to fractures. It is the most common cause of VCF, which is also known as a fragility fracture. People with severe osteoporosis may develop VCF while coughing or sneezing vigorously or while lifting light-weight objects. For individuals with moderate osteoporosis, a fall from a chair, tripping, or trying to lift a heavy object may cause a VCF. Otherwise, in healthy people, a VCF occurs due to severe traumatic injury to the spine, usually resulting from an automobile accident, a sports injury, or a fall from a great height.
- Tumors: A bone tumor may be benign (non-cancerous) or malignant (cancerous). Tumors that affect the bones of the spine are very rare. Malignant spinal tumors commonly spread from other parts of the body through the blood (metastatic tumors). Benign tumors may also develop in the vertebrae and cause pain. Metastatic tumors may be suspected in younger patients below the age of 55 with no history of injury. Tumors can destroy a portion of the vertebra and make it weak and susceptible to fracture.
- Traumatic injuries: A trauma to the spine sustained by an excessively large force, like an automobile collision, can result in multiple VCFs.
Alternative medicine and complementary therapies are sometimes considered good options for achieving relief from pain and combating other symptoms associated with osteoporotic VCFs. There is a wide range of treatment available, each with its own unique theory and practice. These treatments include:
- Herbal medicine: This is the oldest form of medicine and has been used for hundreds of years in most cultures. Certain herbal mixtures can have anti-inflammatory and pain relieving properties, while some herbs are known for reducing muscle spasms. It is important to seek your doctor’s advice before using these remedies, as some herbs may interfere with regular medication.
- Massage therapy: This ancient practice of physical medicine is still used for a wide range of affections. The different techniques of massage involve stroking, kneading, pressing, and warming of the skin and muscles. Massage helps alleviate the stress and anxiety associated with illness and promotes relaxation and general health. It works by stimulating the circulation of blood and lymph, and it helps the body rid itself of toxins. Massage relieves pain through stroking the skin’s nerve endings. The release of endorphins (natural pain relieving chemicals) helps decrease the perception of pain. Although there is no research study suggesting that massage is helpful in relieving pain associated with a fracture, there is some evidence regarding the effectiveness of massage in the treatment of short-term lower back pain and disability. In the case of a spinal fracture, deep muscle massage and spinal manipulation are to be avoided, as pressure on the spine can cause additional fractures. A gentle massage using the fingers or the palms can be effective in alleviating pain and other symptoms.
- Aromatherapy and aromatherapy massage: This method uses fragrant plant-based essential oils to improve well-being and quality of life. These oils are used for gentle massage or added to baths to help relieve stress, insomnia, and depression. Chamomile, rosemary, and lavender are some of the oils known for their pain-relieving properties. These oils are used in diluted form during a gentle massage in order to relieve pain and muscle spasm. There is some research suggesting that lavender oil is helpful in treating back pain and anxiety.
Exercise and movement therapies:
- The Alexander Technique: This therapy involves gentle breathing exercises meant to improve your posture, movements, and spine muscle strength. Some people have found that learning the correct way of using and moving their bodies improves coordination between the head, neck, and back. People who have developed changes in their posture as a result of VCF have found this therapy beneficial.
- Pilates: The Pilates exercise technique was developed in the 1920s by Joseph Pilates. This therapy focuses on correcting your body's alignment. It constitutes an exercise program that helps improve flexibility and strengthen the core muscles of the trunk and pelvic region, which provide support to the skeletal structure of the body. Pilates exercises can also strengthen the spine and its supporting muscle. This, in turn, helps resolve chronic pain associated with spinal fractures that have caused changes in the shape of the spine.
- Yoga: Yoga originated around 6,000 years ago in India and consists of a group of exercises that encourage both physical and mental well-being. It includes different postures, controlled and focused movements, breathing exercises, and meditation. Yoga postures also improve muscle strength. For some people, yoga is helpful in alleviating the pain that occurs due to spinal fractures. In addition, elderly people with osteoporosis may benefit from yoga if special care is taken and potentially risky movements are avoided.
As with any alternative medicine or therapy, it is recommended you seek your doctor’s consent before adopting any new exercise regimen.
The prevention of VCFs can be achieved by taking precautions to prevent osteoporosis or slow down its progress. A few tips to help you avoid osteoporosis later in life include:
- Have a well-balanced diet consistently rich in calcium and vitamin D.
- Take daily dietary supplements of calcium and vitamin D.
- Expose yourself to sunlight, as it stimulates synthesis of vitamin D in your body.
- Perform exercises daily, especially walking, as it is a good weight-bearing exercise.
- Avoid consumption of excessive amounts of alcohol and use of tobacco products.
Do you have unexplained sudden back pain? You can receive information or guidance related to vertebral compression fractures and their treatment from our specially trained spinal surgeons at Cedars-Sinai Marina del Rey Hospital.