Vertebral compression fractures (VCFs) affect millions of people annually, often causing significant pain and limiting daily activities. These fractures occur when one or more bones in the spine collapse, frequently due to osteoporosis, but also from trauma or tumors. Kyphoplasty is a minimally invasive procedure developed to address the pain and structural changes associated with VCFs. A common question arises regarding its applicability, particularly whether kyphoplasty can be performed on older, chronic fractures.
Understanding the Kyphoplasty Procedure
Kyphoplasty is a medical procedure designed to treat painful vertebral compression fractures. It involves a small incision through which a narrow tube, or cannula, is inserted into the affected vertebra, guided by real-time X-ray imaging.
A balloon-like device is then introduced through the tube and inflated within the fractured bone. This inflation creates a cavity and can help restore some of the lost vertebral height.
After the cavity is created, the balloon is deflated and removed. A specialized bone cement, typically polymethylmethacrylate (PMMA), is then injected into the newly formed space. This cement hardens quickly, stabilizing the fractured vertebra. The procedure aims to alleviate pain by stabilizing the bone and reducing painful micro-movements within the fracture.
Treating Older Fractures
While kyphoplasty is often performed on acute, or recent, vertebral compression fractures, it can indeed be an option for older, chronic fractures. The primary reason for considering kyphoplasty in older fractures is persistent, debilitating pain that has not responded to conservative treatments.
Many VCFs heal on their own, but some do not consolidate properly, leading to ongoing pain. In cases of chronic VCFs, the fracture may have formed a “pseudoarthrosis” or non-union, meaning the bone fragments have not fully fused together. This non-union can cause continued instability and pain. Kyphoplasty can stabilize these unhealed fractures, thereby reducing discomfort. The decision to perform kyphoplasty on an older fracture is complex and depends on several factors that indicate the fracture is still the source of pain.
Key Considerations for Older Fractures
Determining if an older vertebral compression fracture is suitable for kyphoplasty involves a thorough evaluation by a spine specialist. The fracture must be the source of ongoing, significant pain, often worsening with movement or weight-bearing activities. Without correlating pain, the procedure is generally not recommended. The specialist’s assessment helps determine if the fracture is still mobile or if there is a pseudoarthrosis that can benefit from stabilization.
Imaging findings play an important role in assessing chronic fractures. Magnetic Resonance Imaging (MRI), particularly sequences like STIR (Short Tau Inversion Recovery), can detect bone marrow edema, which indicates active inflammation or an unhealed fracture site, even in older fractures. Computed Tomography (CT) scans can provide detailed information about fracture stability and bone quality. A bone scan might also be used to confirm metabolic activity at the fracture site, suggesting it is still active and contributing to pain.
Expected Outcomes and Alternative Approaches
Patients undergoing kyphoplasty for older vertebral compression fractures can generally expect pain relief and improved mobility. While the height restoration may not be as dramatic as with acute fractures, significant pain reduction is a common outcome. The procedure aims to stabilize the painful fracture and potentially reduce any associated kyphotic deformity, which is the forward curving of the spine. Outcomes can vary, but many patients report improved quality of life.
For individuals where kyphoplasty is not suitable or desired, several alternative management strategies are available for chronic VCFs. These include conservative approaches such as pain medication, physical therapy, and bracing for support. In rare, severe cases of instability or neurological compromise, open surgical stabilization might be considered.