January 22, 2021 by John Fernandez
Spine Fractures Treated with Surgical ‘Cement’
Vertebral body compression fractures of the spine comprise 750,000 annual cases in the U.S., according to the American Association of Neurological Surgeons. Yet, researchers estimate this number to be much higher, as an estimated two-thirds go undiagnosed, reports the Journal of Multidisciplinary Healthcare.
Causes of Spine Fractures
The most common causes of these spine fractures ares osteoporosis and the deterioration of bone mass that occurs as we age, says Justin Sporrer, M.D., a neurosurgeon with Baptist Health Neuroscience Center. But, fractures also can be caused by heavy lifting, a fall or tumors.
“The vertebrae of our spines are stacked on top of each other,” Dr. Sporrer said. “Just like when you crush a soda can, when these bones collapse on each other, patients will typically experience shrinking of height at the very least and a severe deformity or extreme pain if not treated.”
Common Treatment With a Brace
Often patients who have experienced a fall or injury get checked out by a doctor, who will look for a spinal fracture. Dr. Sporrer says those patients will be treated in a brace for six to eight weeks, allowing the spine to heal itself. For many patients, that treatment works, he says.
Kyphoplasty and Vertebroplasty
But for the patients who experience debilitating pain or lose their ability to stand, walk or function without a visible deficit, Dr. Sporrer often considers minimally invasive vertebral augmentation – known as vertebroplasty or kyphoplasty – to eliminate pain and restore stability, function and quality of life.
“Kyphoplasty involves an outpatient procedure, where we guide a catheter, equipped with a balloon, to the fracture using X-ray guidance,” Dr. Sporrer explained. “Once inside the fracture, we inflate the balloon with saline, alleviating the bone-on-bone compression and often restoring height to the patient.”
Then, the balloon is removed, leaving behind a cavity, which Dr. Sporrer fills with a cement-like substance, known as polymethylmethacrylate (PMMA), that pushes aside any bone fragments within the vertebra and quickly hardens.
In vertebroplasty, no balloon is used. “The cement is injected directly into the bone, much like filling a crack in your home’s foundation with cement,” Dr. Sporrer said.
Dr. Sporrer performs about 75 kyphoplasty procedures a year, and says it takes less than an hour to complete. Patients have immediate stability and complete or significant relief of pain. The procedure can also help prevent progressive kyphosis, which creates a common spinal deformity often referred to as hunchback.
Dr. Sporrer says that doctors have been using variations of vertebral augmentation for 20 years. The most common – and dangerous – risk is the leakage of the cement into the spinal cord or nerves. For neurosurgeons who are familiar with the anatomy of the spine, that risk is minimized. Other complications, according to the National Institutes of Health, include bleeding, infection and fractures to other parts of the body compromised by the low bone density associated with osteoporosis.
Over exposure to X-ray radiation has also been cited, Dr. Sporrer says, but that risk, too, can be minimized through a doctor’s experience with the procedure.
Candidates for Vertebral Augmentation
The No. 1 reason doctors and patients should consider vertebral augmentation is debilitating pain, according to Dr. Sporrer. Doctors also will look to the procedure if a patient’s condition doesn’t seem to be improving with immobilization by a brace, or he or she experiences rapidly declining health as a result of immobilization.
“Most important in these cases is quality of life,” Dr. Sporrer said. “Pain or debilitation of any sort should be evaluated immediately to give these patients the best chance at a successful treatment.”