Vertebral Fractures Treatment Options

Vertebral fractures, often referred to as compression fractures, occur when one or more of the bones in the spine (vertebrae) collapse. These fractures can be caused by osteoporosis, cancer, cancer treatments, infection or trauma, and can be both painful and debilitating. Most often osteoporosis is the cause. Compression fractures affect women more often than men. Trauma is the second most common cause of vertebral fractures typically caused by a motor vehicle accident.

Treatment options for vertebral fractures vary depending on the severity of the fracture, the patient’s overall health, and the underlying cause of the fracture. Common treatment approaches include:

Conservative Management

The goal of conservative management is to reduce pain and improve function.

• Pain Management: Over-the-counter pain relievers, such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), are often used to manage discomfort. In more severe cases, stronger prescription medications may be recommended.
• Bracing: Bracing is often done for patient comfort. A spinal brace may be used to provide support and limit movement during the healing process. The brace helps stabilize the spine, which can reduce pain and prevent further injury.
• Physical Therapy: Once the acute pain subsides, physical therapy is often introduced to improve mobility, strengthen the muscles around the spine, and enhance posture. This can help prevent further fractures and improve overall spine health.
• Activity Modification: Limiting physical activities that place strain on the spine, such as heavy lifting or bending, can help protect the spine during the healing process.

Medications for Osteoporosis

If the fracture is related to osteoporosis, medications that strengthen bones may be prescribed to prevent further fractures.

• Bisphosphonates: These medications slow the breakdown of bone, helping to prevent future fractures.
• Denosumab: This medication works by inhibiting bone resorption, a process that weakens bones.
• Teriparatide: A form of parathyroid hormone that stimulates new bone growth and can be particularly effective for severe osteoporosis.

Minimally Invasive Surgical Treatments

In cases where conservative management is ineffective or if the fracture causes significant persistent pain, loss of height or deformity, surgical intervention may be considered. The goal is to ensure spinal stability and preserve neurological function. The two most common minimally invasive surgeries for vertebral fractures are:

• Vertebroplasty: This procedure involves injecting bone cement into the fractured vertebra to stabilize it and relieve pain. The procedure is done under imaging guidance and can provide immediate pain relief in many cases. Vertebroplasty is typically used for compression fractures due to osteoporosis and is effective in reducing pain quickly. This is usually an outpatient procedure that takes a few hours.
• Kyphoplasty: Similar to vertebroplasty, kyphoplasty also uses bone cement. However, in this procedure, a small balloon is first inserted and inflated to create space before the cement is injected. This technique not only stabilizes the fracture but may also restore some of the vertebra’s height, which can help improve posture and alleviate pain.

Surgical Interventions

In severe cases, especially if the fracture is unstable or associated with neurological symptoms, traditional surgery may be necessary.

• Spinal Fusion: This involves fusing the broken vertebrae together to stabilize the spine and relieve pain. It may require metal rods, screws, or plates to hold the spine in position. This is open surgery to relieve pressure on the nerves or spinal cord when the fracture compromises spinal stability.
• Decompression Surgery: If the fracture is pressing on the spinal cord or nerves, decompression surgery may be required to relieve pressure and prevent further neurological damage.

Lifestyle and Long-Term Management

In addition to medical and surgical treatments, long-term management is crucial to prevent further vertebral fractures and maintain spinal health:

• Diet and Nutrition: Adequate intake of calcium and vitamin D is important for maintaining bone density.
• Regular Exercise: Weight-bearing and strength-training exercises can help improve bone health and prevent future fractures.
• Fall Prevention: Preventing falls is essential in individuals with weakened bones, especially those with osteoporosis. Modifying the home environment, wearing proper footwear, and addressing balance issues through physical therapy can reduce the risk of falls.

Vertebral fracture treatment options range from conservative measures like pain management and bracing to minimally invasive surgeries such as vertebroplasty and kyphoplasty, depending on the severity and cause of the fracture. Open surgery may be necessary in certain cases. Long-term management, including medications for osteoporosis and lifestyle modifications, plays a critical role in preventing future fractures.

Contact Dr. Girardi to schedule a consultation to learn more about your condition and discover all you treatment options. Dr. Girardi offers personalized expert orthopedic care to patients in New York, New Jersey, Connecticut and the Capital District Region, as well as international patients.

References

• Whitney E, Alastra AJ. Vertebral Fracture. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547673/