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Common Questions About Spinal Fractures
What is a spinal fracture?
Fractures to the bones in your spine (vertebrae) are called spinal fractures. They are also referred to as vertebral compression fractures (VCFs), or simply, compression fractures. Spinal fractures occur as a result of bone loss resulting from conditions like osteoporosis or a trauma to the spine. Sudden back pain is one of the symptoms of a spinal fracture, although a spinal fracture can occur without any immediately obvious symptoms. Over time, multiple fractures can cause alterations in posture, such as a rounded back or dowager’s hump.
Because back pain or changes in posture are often mistaken as a normal part of aging, it’s important to see a doctor if you notice a change in your posture or have back pain. If spinal fractures are not diagnosed and treated, they can contribute to chronic back pain, a reduced quality of life, and an increased risk for more spinal fractures.4,5,6,8,9,12,15,16
Are spinal fractures difficult to diagnose?
Spinal fractures tend to be under-recognized by doctors and patients alike. About two-thirds of all osteoporosis-related spinal fractures aren’t diagnosed,2,17 primarily because:
- Patients with spinal fractures may have mild, or very little discomfort1
- Patients may consider back pain a normal part of aging1
- Patients and doctors may not realize the importance of proper diagnosis1
A complete physical exam, together with an X-ray and/or magnetic resonance imaging (MRI), can help your doctor differentiate between pain caused by a spinal fracture or pain caused by other disorders.
Why should I be concerned about spinal fractures?
Just one spinal fracture can increase your risk for another spinal fracture to 3-5 times more than it was before the initial fracture occurred7,16. This risk increase occurs because the broken bone (vertebra) affects the distribution of weight along the spinal column. Misalignment brought on by a fractured vertebra places more stress on adjacent vertebrae. In short, the spine is forced to withstand more stress or weight with fewer functioning parts, resulting in a structure that’s weakened and more vulnerable to additional vertebral compression fractures.
What are the symptoms of a spinal fracture?
Most spinal fractures have a gradual onset, unrelated to specific injury. Spinal fractures can occur as a result of normal activity, like bending over or reaching for something. In some cases, patients experience sudden and severe back pain without engaging in activity at all.
Because spinal fracture can be easily confused with other back problems, many spinal fracture patients don’t receive proper diagnosis and treatment.
To complicate proper diagnosis even more, a spinal fracture may not show up on an X-ray for several weeks, even when the patient is experiencing pain. If your doctor does not find a fracture on the initial X-ray, but you have persistent back pain with no clear cause, consider asking for a second imaging study. In some cases, your doctor may order magnetic resonance imaging (MRI) to confirm a diagnosis of spinal fracture.
Can spinal fractures affect my overall health?
Multiple vertebral compression fractures can cause a forward curvature of the spine known as “kyphosis.” This increases your risk for future fracture and can reduce your quality of life. With each additional fracture, the spinal curvature can become more pronounced, painful and debilitating. Severe kyphosis can reduce the space in your thoracic cavity and compress your organs, making it difficult to breathe, walk, eat, or sleep. Lung capacity can become reduced, which can affect your stamina and restrict your mobility. Early satiety (a feeling of fullness after having eaten only a small amount) can cause you to lose weight and become malnourished. In addition, sleep disorders are common with pronounced kyphosis.3,5,6,8,9,10,11,12,13,14,15
What are the psychological effects of spinal fractures?
In addition to medical complications, patients with spinal fractures can experience depression, anxiety, and lowered self-esteem. The alterations in lifestyle that accompany severe kyphosis can profoundly affect well-being and cause feelings of isolation and sadness. 5,9,12,18
What is osteoporosis?
Osteoporosis is a disease that causes the bones to become fragile and weak, making them break more easily than normal. Often referred to as ”the silent thief,” osteoporosis usually progresses and “steals” bone without obvious signs or symptoms until the first fracture occurs.
Who is at risk for an osteoporosis-related fracture?
The International Osteoporosis Foundation estimates that 40% of women and 15% of men over the age of 50 will have one or more osteoporosis-related fractures in their remaining lifetime. Long-term use of medications such as corticosteroids can weaken bone, making it more susceptible to fracture. Medical treatments like chemotherapy and radiation therapy have been shown to cause bone loss. Finally, lifestyle choices and genetic factors can adversely affect bone density.19
Is osteoporosis preventable?
Osteoporosis prevention should begin in childhood with a calcium-rich diet, regular weight-bearing exercise and either safe exposure to sunshine or vitamin D supplementation. In adulthood, continuing to eat foods rich in calcium, getting sunshine or taking vitamin D, regular exercise and avoidance of smoking and excessive alcohol use can help your body maintain healthy bone.
What are the risk factors for osteoporosis?
In 2010, the National Osteoporosis Foundation identified the following risk factors for osteoporosis:1
- Prolonged use of medications like steroids and certain cancer medications
- Low levels of the sex hormone testosterone (in men)
- Low levels of the sex hormone estrogen (in women)
- Smoking and excessive alcohol intake
- History of broken bones
- Inadequate physical exercise or
- Dietary factors, such as low intake of calcium or vitamin D, and high intake of salt and caffeine
- Age—as you get older, bone loss increases
- Family history
- Gender—osteoporosis is more common in women
How common are fractures caused by osteoporosis?
The International Osteoporosis Foundation estimates that 40% of women and 15% of men over the age of 50 will have one or more osteoporosis-related fractures in their remaining lifetime.19
How does normal back pain compare with the pain from a spinal fracture?
There are many potential sources of back pain unrelated to fracture, but sudden, severe back pain unrelated to specific injury, may indicate that a spinal fracture has occurred. Regardless of the intensity of back pain, it’s never wise to self-diagnose. Patients with back pain should see their doctor for a physical exam.
What can happen if a spinal fracture isn’t diagnosed and treated?
One spinal fracture can lead to another, possibly resulting in kyphosis (curvature of the spine) and an overall decline in health. Kyphotic deformity and progressive bone loss increase your risk for additional fractures and can adversely affect your ability to breathe, walk, eat, or sleep. Consult with your doctor to determine your condition and the appropriate treatment.3,4,5,6,8,9,10-16
What is balloon kyphoplasty?
Balloon kyphoplasty is a minimally invasive procedure designed to repair vertebral compression fractures (VCFs) by reducing and stabilizing the fractures. It has been clinically shown to be more effective than nonsurgical care for reducing the fracture, relieving back pain, and improving mobility and quality of life.20
Unlike other treatments, balloon kyphoplasty utilizes orthopedic balloons to restore vertebral body height and correct angular deformity. Balloons are guided through working cannulae into the vertebra and carefully inflated to reduce the spinal fracture.
After reduction, the balloons are deflated and removed. The resulting cavity (void) allows for a controlled deposition of KYPHON® bone cement, forming an internal cast and stabilizing the fracture.
Are there risks associated with balloon kyphoplasty?
The complication rate for KYPHON® Balloon Kyphoplasty has been demonstrated to be low. There are risks associated with the procedure, including serious complications, and though rare, some of which may be fatal. These include, but are not limited to heart attack, cardiac arrest (heart stops beating), stroke, and embolism (blood, fat or cement that migrates to the lungs, heart, or brain). Other complications include infection and leakage of bone cement into the muscle and tissue. Cement leakage into the blood vessels may result in damage to the blood vessels, lungs, heart, and/or brain. Cement leakage into the area surrounding the spinal cord may result in nerve injury that can, in rare instances, cause paralysis. A prescription is required. Please consult your physician for a complete list of indications, contraindications, benefits, and risks. Only you and your physician can determine whether this procedure is right for you.
What were the results of the clinical study comparing balloon kyphoplasty and nonsurgical treatment?
In the largest randomized controlled trial, FREE study, Balloon kyphoplasty was shown to be more effective than nonsurgical care for the treatment of acute vertebral compression fractures. Patients treated with balloon kyphoplasty had faster and greater improvement in back pain relief, back function, and quality of life at one month after surgery. The benefits of balloon kyphoplasty were sustained on average through 12 months. The overall frequency of patients with adverse events did not differ between the balloon kyphoplasty and the nonsurgical groups.20
Important Safety Information
The complication rate with KYPHON® Balloon Kyphoplasty has been demonstrated to be low. There are risks associated with the procedure (for example, cement leakage), including serious complications, and though rare, some of which may be fatal. This procedure is not for everyone. A prescription is required. Please consult your physician for a complete list of indications, contraindications, benefits, and risks. Only you and your physician can determine whether this procedure is right for you.
- National Osteoporosis Foundation, 2010.
- Delmas, P.D., et al., Underdiagnosis of vertebral fractures is a worldwide problem: the IMPACT study. J Bone Miner Res, 2005. 20(4): p. 557-63.
- Schlaich, C., et al., Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int, 1998. 8(3): p. 261-7.
- Lindsay, R., S. Pack, and Z. Li, Longitudinal progression of fracture prevalence through a population of postmenopausal women with osteoporosis. Osteoporos Int, 2005. 16(3): p. 306-12.
- Lyles, K.W., et al., Association of osteoporotic vertebral compression fractures with impaired functional status. Am J Med, 1993. 94(6): p. 595-601.
- Silverman, S.L., et al., The relationship of health-related quality of life to prevalent and incident vertebral fractures in postmenopausal women with osteoporosis: results from the Multiple Outcomes of Raloxifene Evaluation Study. Arthritis Rheum, 2001. 44(11): p. 2611-9.
- Ross, P.D., et al., Pre-existing fractures and bone mass predict vertebral fracture incidence in women. Ann Intern Med, 1991. 114(11): p. 919-23.
- Silverman SL. The clinical consequences of vertebral compression fracture. Bone 1992;13 Suppl 2:S27-31.
- *†Gold DT, Silverman SL. The downward spiral of vertebral osteoporosis: consequences (Monograph). Cedars-Sinai Medical Center 2003.
- Leech JA, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis 1990;141(1):68-71.
- Greendale GA, Barrett-Connor E, Ingles S, Haile R. Late physical and functional effects of osteoporotic fracture in women: the Rancho Bernardo Study. J Am Geriatr Soc 1995;43(9):955-61.
- Pluijm SM, Tromp AM, Smit JH, Deeg DJ, Lips P. Consequences of vertebral deformities in older men and women. J Bone Miner Res 2000;15(8):1564-72.
- Fink HA, Ensrud KE, Nelson DB, et al. Disability after clinical fracture in postmenopausal women with low bone density: the fracture intervention trial (FIT). Osteoporos Int 2003;14(1):69-76.
- Nevitt MC, Ettinger B, Black DM, et al. The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 1998;128(10):793-800.
- van Schoor NM, Smit JH, Twisk JW, Lips P. Impact of vertebral deformities, osteoarthritis, and other chronic diseases on quality of life: a population-based study. Osteoporos Int 2005;16(7):749-56.
- Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. Jama 2001;285(3):320-3.
- Cooper C, Atkinson EJ, O'Fallon WM, Melton W III. Incidence of clinically diagnosed vertebral fractures: A population based study in Rochester, Minnesota, 1985-1989. J Bone Min Res. 1992;7:221-227.
- *Gold DT, Stegmaier K, Bales CW, Lyles KW, Westlund RE, Drezner MK. Psychosocial functioning and osteoporosis in late life: Results of a multidisciplinary intervention.J Womens Health. 1993;2:149-155.
- Int'l Osteoporosis Foundation (www.osteofound.org)
- *† Wardlaw D, Cummings SR, Van Meirhaeghe J, et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. The Lancet. 2009; 373:1016-24
Disclosure:an asterisk (*) denotes that some/all of the authors are paid Medtronic consultants. A cross (†) indicates that research cited may have been funded partially, or in whole, by Medtronic.