Conservative options have included: a short period of bed rest (without prolonged periods of inactivity, especially in the elderly); oral analgesics; local steroid or analgesic injections; back braces and/or physical therapy, and anti-inflammatory drugs.
Today however, patients who fail conservative management and continue to have severe pain and/or disability have other options. These patients may be candidates for either of two therapeutic and preventive treatments for compression fractures, called vertebroplasty/percutaneous vertebroplasty or percutaneous vertebral augmentation, e.g., kyphoplasty.
Vertebroplasty was developed in France by Dr. Herve Deramond and his colleagues in 1986. The procedure has been performed in the United States since 1995. Vertebroplasty is a minimally invasive, nonsurgical procedure designed to relieve the pain of compression fractures. In addition to relieving pain, vertebral bodies that are weakened but not yet fractured can be strengthened, thereby preventing future problems.
Percutaneous vertebroplasty involves injecting a small amount of medical grade acrylic cement, called polymethylmethacrylate (PMMA), into the collapsed vertebra to stabilize and strengthen the fracture and vertebral body. The cement is injected into the vertebral body as a viscous paste, but it hardens rapidly.
Most patients are ambulatory within a few hours after the procedure, and experience significant improvement or even full recovery from their fracture symptoms within six to twelve weeks, and can return to a normal exercise program once the fracture has fully healed.
Percutaneous Vertebral Augmentation
Percutaneous Vertebral Augmentation, a newer treatment option, is also a percutaneous and minimally invasive procedure. The procedure involves the use of a device to create a void within the vertebral body. This is followed by delivery of bone cement into the void to strengthen the vertebra.
Percutaneous Vertebral Augmentation is performed under local or general anesthesia. Using image guidance x-rays, a small incision is made and a device is inserted into the center of the vertebral body to the site of the fractured bone. A cavity or space created by the device is then filled with PMMA, the same orthopedic cement used in vertebroplasty, binding the fracture. The cement hardens quickly, providing strength and stability to the vertebra, and relieving pain.
Procedures such as vertebroplasty and percutaneous vertebral augmentation with cavity creation provide substantial benefits, including pain relief, stabilization of bone fractures, and reducing the debilitating effects of progressive osteoporosis. Compared to traditional surgical procedures, these procedures generally require less time to accomplish, less anesthesia, a shorter stay at the medical facility, and quicker return to normal activity.