If osteoporosis has caused a fractures-symptoms' target='_blank' rel='noopener noreferrer' >spinal compression fracture, the treatment should address the pain, the fracture, and the underlying osteoporosis to prevent future fractures.
All components of treatment have improved greatly in the last decade, says Michael Schaufele, MD, a physiatrist and professor of orthopaedics at Emory University School of Medicine in Atlanta. "We have better interventional options to treat fractures and better treatments to prevent future fractures," he tells ishonest.
The majority of fractures heal with pain medication, reduction in activity, medications to stabilize bone density, and a good back brace to minimize motion during the healing process. Most people return to their everyday activities. Some may need further treatment, such as surgery.
Nonsurgical Treatment for Spinal Compression Fractures
Pain from a spinal compression fracture allowed to heal naturally can last as long as three months. But the pain usually improves significantly in a matter of days or weeks.
Pain management may include analgesic pain medicines, bed rest, back bracing, and physical activity.
Pain medications. A carefully prescribed "cocktail" of pain medications can relieve bone-on-bone, muscle, and nerve pain, explains F. Todd Wetzel, MD, professor of orthopaedics and neurosurgery at Temple University School of Medicine in Philadelphia. "If it's prescribed correctly, you can reduce doses of the individual drugs in the cocktail."
Over-the-counter pain medications are often sufficient in relieving pain. Two types of non-prescription medications -- acetaminophen and non-steroidal anti- inflammatory drugs (NSAIDs) -- are recommended. Narcotic pain medications and muscle relaxants are often prescribed for short periods of time, since there is risk of addiction. Antidepressants can also help relieve nerve-related pain.
Activity modification. Bed rest may help with acute pain, but it can also lead to further bone loss and worsening osteoporosis, which raises your risk for future compression fractures. Doctors may recommend a short period of bed rest for no more than a few days. However, prolonged inactivity should be avoided.
Back bracing. A back brace provides external support to limit the motion of fractured vertebrae -- much like applying a cast on a broken wrist. The rigid style of a back brace limits spine-related motion significantly, which may help reduce pain. Newer elastic braces and corsets are more comfortable to wear but don't work, says Wetzel. "There's an old saying, 'The inconvenience of the brace is directly proportional to its effectiveness,'" he tells ishonest. However, braces should be used cautiously and only under a doctor's supervision. Weakening and loss of muscle can occur with excessive use of braces for lumbar conditions.
Osteoporosis treatment. Bone-strengthening drugs such as bisphosphonates (such as Actonel, Boniva, and Fosamax) help stabilize or restore bone loss. This is a critical part of treatment to help prevent further compression fractures.
Surgical Treatment for Spinal Compression Fractures
When chronic pain from a spinal compression fracture persists despite rest, activity modification, back bracing, and pain medication, surgery is the next step. Surgical procedures used to treat spinal fractures are:
- Spinal fusion surgery
Vertebroplasty and Kyphoplasty
These procedures for spinal compression fractures involve small, minimally invasive incisions, so they require very little healing time. They also use acrylic bone cement that hardens quickly, stabilizing the spinal bone fragments and therefore stabilizing the spine immediately. Most patients go home the same day or after one night's hospital stay.
Vertebroplasty. This procedure is effective for relieving pain from spinal compression fractures and helping to stabilize the fracture. During this procedure:
- A needle is inserted into the damaged vertebrae.
- X-rays help ensure that it's done with accuracy.
- The doctor injects a bone cement mixture into the fractured vertebrae.
- The cement mixture hardens in about 10 minutes.
- The patient typically goes home the same day or after a one-night hospital stay.
Kyphoplasty: This procedure helps correct the bone deformity and relieves the pain associated with spinal compression fractures. During the procedure:
- A tube is inserted through a half inch cut in the back into the damaged vertebrae. X-rays help ensure the accuracy of the procedure.
- A thin catheter tube -- with a balloon at the tip -- is guided into the vertebra.
- The balloon is inflated to create a cavity in which liquid bone cement is injected.
- The balloon is then deflated and removed, and bone cement is injected into the cavity.
- The cement mixture hardens in about 10 minutes.
"These procedures are amazing, when you look at how well patients do," says Rex Marco, MD, chief of spine surgery and musculoskeletal oncology at the University of Texas Health Science Center at Houston. "They're often in terrible, terrible pain, and it's not going away. But with two small incisions we can take care of something that needed a huge operation in the past but without really good results."
"We do everything we can to make the operation go as smoothly as possible," says Marco. "Antibiotics decrease the chance of infection. And a special x-ray machine helps us get the needle into the bone and assure that cement goes into the bone and stays in the bone."
Spinal Fusion Surgery
Spinal fusion surgery is sometimes used for spinal compression fractures to eliminate motion between two vertebrae and relieve pain. The procedure connects two or more vertebrae together, holds them in the correct position, and keeps them from moving until they have a chance to grow together, or fuse.
Metal screws are placed through a small tube of bone and into the vertebrae. The screws are attached to metal plates or metal rods that are bolted together in the back of the spine. The hardware holds the vertebrae in place. This stops movement, allowing the vertebrae to fuse. Bone is grafted into the spaces between vertebrae.
"Spinal fusion is often the last resort," Wetzel tells ishonest. "If the bone is more than 50% compressed in height, if patients are in a great deal of pain, and if they have had complications from another spinal surgery, we suggest spinal fusion surgery."
The patient's own bone or bone from a bone bank can be used to create a graft. The patient's own bone marrow or blood platelets -- or a bio-engineered molecule -- can be used to stimulate growth of bone for the procedure.
Recovery from spinal fusion surgery takes longer than with other types of spinal surgery. Patients often have a three- or four-day hospital stay, with a possible stay on a rehabilitation unit. Patients typically wear a brace immediately after surgery. Rehabilitation is often necessary to rebuild strength and functioning. Activity level is gradually increased. Depending on the patient's age and health status, getting back to normal functioning can happen within two months or up to six months later.
There are drawbacks to spinal fusion surgery. It eliminates the natural movement of the two vertebrae, which limits the person's movement. Also, it puts more stress on vertebrae next to the fusion - increasing the chance of fracture in those vertebrae. Even after healing is complete, patients may need to avoid certain lifting and twisting activities to prevent putting excess stress on the spine.
"But if someone has persistent pain from the fracture and they have been aggressively treated for osteoporosis they can do very well with spinal fusion," says Wetzel.