Repairing Compression Fractures: Key Research Bolstered Success of Minimally Invasive Procedures

Vertebral compression fractures most often occur in people with severe osteoporosis who have weak or brittle bones. Common daily activities can cause a segment of the bony block in the spine to collapse, which can lead to severe pain, deformity and loss of height.

These so-called compression fractures can also occur in cancer patients, more frequently the result of tumors that have spread to the vertebrae, the bones in your back that are stacked on top of each other. Fortunately for patients who suffer compression fractures, minimally invasive procedures — kyphoplasty and vertebroplasty — were introduced in the 1990s and have evolved to the point that most patients are spared complex and potentially debilitating invasive surgeries, explains Frank Vrionis, M.D., director of Marcus Neuroscience Institute at Boca Raton Regional Hospital, part of Baptist Health South Florida.

“That’s the most common factor in cancer patients with compression factors — when cancers that spread from somewhere else to the spine,” said Dr. Vrionis. “And by doing so, destroying part of the vertebral body. And that causes a lot of pain. Sometimes, they can cause neurological issues and stability issues.”

Over the last decade, Dr. Vrionis has been involved in pioneering research that has bolstered kyphoplasty as the primary procedure for compression fractures, helping ensure quick recoveries with minimal pain and minimal disruption in quality of life for cancer and osteoporosis patients.

During kyphoplasty, the neurosurgeon inflates one or two small balloon-like devices into the broken vertebra to partly restore the height of the vertebra. The balloon(s) can then be removed or left in place in the vertebra. A cement-like material is injected into the cavity created by the balloon(s). With vertebroplasty, there are no balloons — just injections of a cement-like material into the fractured vertebra to make it more stable.

“Twenty years ago, these types of fractures were treated with major surgeries, with instrumentation and with screws and rods,” explains Dr. Vrionis. “These were dangerous surgeries, which was hard for patients with cancer to go through.”

But 20 years ago, Dr. Vrionis says there were “many deniers” who did not believe that kyphoplasty was a valid alternative to major surgery. Before joining Marcus Neuroscience Institute, Dr. Vrionis took part in many meetings over the years on the topic of kyphoplasty, and he would co-author studies validating the minimally invasive procedure’s success for patients with compression fractures.

Two articles he co-authored regarding “controversial issues” in Kyphoplasty and Vertebroplasty in Osteoporotic Vertebral Fractures and Kyphoplasty and Vertebroplasty in Malignant Vertebral Fractures, helped debunk two previous randomized trials that claimed the two procedures were ineffective.

“Evolution in hardware design and cement properties enables the operator to do the procedure faster and more safely,” one of the studies concluded.

“We ran the studies and proved that kyphoplasty is something that does work and should be done for these patients, instead of the risky and more extensive surgeries,” said Dr. Vrionis. “Now, (kyphoplasty and vertebroplasty) is the standard of care for these patients, here at the Institute and throughout the United States.”