Vertebral body fractures are most often seen in post-menopausal women, although they can also occur in younger women and also in men if there are predisposing factors that can lead to bone weakness, such as traumatic injury, poor diet, metabolic disorder, or the long-term use of steroids.
They normally present as a sudden onset of pain in the region of the thoracic or lumbar spine, often with associated kyphosis (forward angulation of the spine), which shifts the body’s centre of gravity in front of the feet, making it more likely that someone will fall over and suffer another fracture. Where possible, it is important to correct the biomechanical abnormality within a few weeks of the fracture but where this is not possible we can treat the fracture to fix the broken bone fragments which is normally effective at controlling the pain within hours.
There are three treatments that we commonly use for vertebral body fractures. The simplest is vertebroplasty, which involves the image guided injection of liquid bone cement (polymethyl methacrylate - PMMA) into the fractured vertebra. This liquid bone cement solidifies within 10-20 minutes, fixing the fracture as soon as it hardens.
The second procedure is balloon kyphoplasty, which involves inserting inflatable bone tamps under image guidance into the fractured vertebral body. These are then inflated under image guidance and the process of inflation can cause some fracture reduction. The bone tamps are then deflated and removed, leaving cavities inside the vertebral bodies which are then filled with PMMA.
To hold the fractured vertebrae in position a more recently developed treatment is SpineJack®. Two identical devices, very similar in structure and function to conventional car jacks, are inserted under image guidance through the pedicle of the affected vertebral body into the fractured vertebral body. They are then expanded and they can produce impressive fracture reduction and normalisation of vertebral body anatomy. The SpineJacks® are left in place and liquid PMMA is injected around then to fix the reduced fracture.
The management of vertebral body fractures is a rapidly evolving specialist field and new techniques and devices are regularly emerging. The presentation and management of vertebral body fractures in many cases is similar to the management of spinal metastases, spinal haemangiomas or vertebral multiple myeloma. These can all be treated with vertebroplasty, balloon kyphoplasty and procedures such as SpineJack®. If you think you, or a loved one, might have suffered a vertebral body fracture please get in touch with us.