Vertebral Body Fractures are a fracture of the vertebrae (bones of the spine) that eventually cause a collapse of the vertebral body. These fractures are most commonly located in the thoracic spine (the middle portion of the spine). The major risk factor for vertebral body fractures are increasing age and occur when the upper body weight exceeds the ability of vertebrae to support the load. Although more frequently seen in women, men can be affected as well (Old, 2004).

Certain conditions that can produce chronic pain affecting the vertebrae include spinal stenosis, vertebral body fractures, Osteoporosis, Osteoarthritis, spondylolisthesis, neoplasms (Primary vs. metastatic lesions), and infections. Vertebroplasty and Kyphoplasty are extremely effective treatments for many of these conditions.

Diagnosis

Your physician will perform a physical exam and may find tenderness over the vertebrae as well as kyphosis (curving of the spine). Other manifestations of nerve involvement include constipation, loss of lower extremity reflexes, and the sensory function. The physician may also order radiological imaging. An x-ray commonly ordered to see the classic wedge-shaped vertebral body with narrowing of the anterior portion in most compression fractures. However, the physician may want to order additional studies such as MRI, CT scan, or a bone scan.

Treatment

NSAID’s and analgesics are used in the acute management of pain to help relieve discomfort. Patients can also be treated with some bed rest.

Patients that do not respond to the more conservative management described above may be good candidates for minimally invasive procedures by your pain physician that have been proven effective, including Vertebroplasty and Kyphoplasty (Old 2004). Results of a clinical research trial concluded that both Vertebroplasty and Kyphoplasty significantly reduce pain and improve mobility in patients with vertebral fracture (De Negri 2007). Vertebroplasty is a procedure which involves injecting acrylic cement into the fractured vertebra to stabilize and strengthen the vertebrae. Kyphoplasty is a method that involves placing an inflatable balloon into the vertebral body. When the balloon is inflated, it makes a space in the center of the vertebrae where an acrylic is injected.

There is good evidence that diagnosing and treating Osteoporosis reduces the incidence of compression fractures of the spine (Kim 2006). Consistent exercise and activity to help with muscle strengthening and flexibility should also be done to help decrease vertebral fractures and back pain associated with Osteoporosis.

Journal Articles

• Osteoporotic compression fractures of the spine; current options and considerations for treatment Kim DH, Vaccaro AR. Spine J. 2006 Sep-Oct;6(5):479-87 PMID: 16934715

• Vertebral Compression Fractures in the Elderly. Old, Jerry; Calvert, Michelle. American Family Physician. January 1, 2004 What is osteoporosis? Christodoulou C, Cooper C. Postgrad Med J. 2003 Mar;79(929):133-8. PMID: 12697910

• Treatment of painful osteoporotic or traumatic vertebral compression fractures by percutaneous vertebral augmentation procedures: a nonrandomized comparison between vertebroplasty and kyphoplasty. De Negri P, Tirri T, Paternoster G, Modano P. Clin J Pain. 2007 Jun;23(5):425-30 PMID: 17515741