Chapter 12 - Vertebral Compression Fracture Treatments

Abstract

Patients with acutely painful vertebral body compression fractures managed non-operatively, have impaired health and reduced quality of life caused by the resulting kyphotic deformity independent of acute fracture pain. The changes in spinal alignment increase future fracture risk, including adjacent fractures. Vertebroplasty and balloon kyphoplasty are minimally invasive procedures that stabilize the fractured vertebral body, while balloon kyphoplasty is also designed to correct the spinal deformity. Both procedures provide immediate and sustained relief of pain. Two concurrently controlled studies show that balloon kyphoplasty improves pain and quality of life outcomes compared to non-operative management, while reducing the number of future (and adjacent) fractures. There are acrylic and calcium cements in use or in development for these procedures. None of the cements today have all the desired characteristics. While there are theoretical advantages of newer cements, polymethyl methacrylate (PMMA) has a long history of successful use in areas of compressive loading, including the vertebral body. The biomechanics of the spine predict that kyphosis itself increases the risk of future fracture, especially adjacent fractures, and the osteoporosis literature demonstrates this. These studies support the goal of correcting sagittal alignment whenever possible.