Cement Away the Pain Of Spinal Compression Fractures

By Varada Nargund, DO

Spinal compression fractures (SCF) are the most common types of spinal fractures and occur more often in older Caucasian and Asian women with a pre-existing condition of osteoporosis. Unfortunately, many women over the age of 50 who experience SCF mistakenly attribute the pain to a muscle pull, back strain or arthritis. Consequently, the condition often goes undiagnosed and untreated, opening the door potentially for progressive spinal deformity and disability later in life.

A common culprit of SCF, osteoporosis weakens vertebral bones to where they are easily susceptible to collapsing down onto themselves. Even simple actions such as lifting a bag of groceries, missing a step, coughing, sneezing and twisting may result in fractures that cause progressive pain and deformity.

The fractured bone collapses into a wedge, which causes an angulated curvature, or “hunch back” posture of the spine known as kyphosis. Kyphosis can cause reduced lung capacity, abdominal distension and increased pressure on the hips. Less frequently, it also increases pressure on the nerves and on the spinal cord itself, which can lead to paralysis and spinal cord damage if left untreated.

Beyond osteoporosis, other common causes of SCF include direct traumatic injury, and, less frequently, the spread of metastatic cancer to the spine. Risk factors include hormone deficiency, smoking tobacco, excessive alcohol intake, and lack of exercise. A diet low in calcium and vitamin D and a history of previous SCF increase the risk even more.

In the absence of a traumatic injury, pain from a SCF may be slowly progressive and often starts as a dull ache before becoming more severe. It may mimic sciatica into the leg or may travel around the rib cage and worsen with respiration. Coughing, sneezing and breathing deeply may further aggravate the pain.

Accurate diagnosis of SCF by an expert physician is critical, and can be achieved through a complete history and physical examination combined with blood tests, DEXA scans and specific MRI studies to assess the extent and acuity of the fracture.

Fortunately, if SCF is accurately diagnosed it can be treated very effectively without surgery. Proper care and early detection can greatly enhance treatment options and prevent further disability.

An innovative non-surgical treatment called vertebroplasty offers a quick and effective way to treat the fracture and subsequent pain. Using X-ray guidance, a small needle is guided into the fractured bone under local anesthesia. After positioning the needle in the fracture site, bone cement is injected under live fluoroscopic X-ray guidance. The cement hardens rapidly and repairs the fracture site and prevents further collapse by strengthening the weakened bone.

Performed safely in an outpatient setting, vertebroplasty has proven to be highly successful, often providing substantial and immediate pain relief. Combined with medical treatment of osteoporosis and a customized functional rehabilitation program, patients can achieve excellent results with comprehensive non-surgical care aimed toward both relieving pain and restoring quality of life.