Approximately 700,000 vertebral compression fractures occur in the United States every year. Vertebral compression fractures have likely received little attention because of the perception that they are benign, self-limited problems and because there are few treatment options. Typically, treatment of vertebral compression fractures consists of pain management, rehabilitation and prevention of additional fractures. Most symptomatic fractures are adequately managed with bed rest, activity modification, analgesia and a brace. However, each year up to 150,000 vertebral compression fractures require hospitalization with prolonged bed rest and intravenous pain medication.

Vertebroplasty has been used to treat patients with intractable pain from vertebral compression fractures. Both vertebroplasty and kyphoplasty involve injecting cement into the vertebral body to stabilize the fracture fragments and relieve pain. In vertebroplasty, a needle is inserted through the patient’s skin and into the fractured vertebral body. After the needle is placed, the neurointerventionalist slowly injects acrylic bone cement into the fracture site. The cement hardens and stabilizes the affected vertebrae.

Lateral image of cement being injected into a severely collapsed vertebral body.

Kyphoplasty is similar to vertebroplasty, but involves inflating a balloon tamp in the vertebral body to restore fracture height. Both procedures are minimally invasive and can be performed with local anesthesia and mild sedation.  Up to 95% of patients notice pain reduction within 24 hours.

Both vertebroplasty and kyphoplasty can also be used to treat painful metastatic lesions of the spine. Pain relief is reported in 80-95% of patients.  Radiation therapy and chemotherapy can be used in conjunction with the vertebral augmentation.

Lateral image of the thoracic spine showing balloons inflated in a compressed, osteoporotic vertebral body.

Lateral image of the thoracic spine after deposition of cement in vertebral bodies.

Sacroplasty

Sacral insufficiency fractures are osteoporotic fractures of the sacrum that have very limited treatment options.  Recently, vertebroplasty techniques have been modified to treat these fractures, with good relief of pain.

Frontal image of the pelvis showing cement in both sides of the sacrum after sacroplasty.