Spinal Compression Fracture Surgery
Sometimes surgery is required for spinal compression fractures, no matter
the cause. The goal of the surgery is to fuse and repair the fracture,
eliminate back pain, and restore posture and ease of movement. The most
common surgical procedures for spinal compression fractures are lumbar
fusion and vertebroplasty/kyphoplasty.
In a lumbar fusion, the vertebrae are connected with rods.
Minimally invasive lumbar fusion joins the bones of the spine in the lower back together so that there
is no longer any motion between them. This procedure can repair a fracture;
correct deformity; and reduce spinal pressure, pain, and nerve damage.
Minimally invasive lumbar fusions do not require the large incision or
the muscle retraction typically used in conventional fusions. Patients
undergoing this procedure have a fast recovery time. A recent advance
is the use of a computerized image guidance system for many patients undergoing
lumbar fusion. This has the advantage of aiding the surgeon in optimal
placement of screws and avoiding injury to delicate nerve tissue.
Until recently, all patients undergoing lumbar fusion required a bone or
synthetic graft either from the hip region or from a bone bank. In most
patients undergoing lumbar spinal fusion, metal titanium instrumentation
is also used. This will typically involve placing pedicle screws into
the bone and connecting these with a rod.
In a vertebroplasty, the surgeon advances a needle through the skin on
a patient’s back under x-ray guidance to confirm that it has entered
the fractured vertebra (left). The surgeon then injects bone cement into
the fractured vertebra (right), where it quickly hardens to provide stability
to the bone and relief of pain.
Vertebroplasty and Kyphoplasty: Advanced procedures such as kyphoplasty and vertebroplasty allow neurosurgeons
to reconstruct compressed vertebral bone, restore alignment, or remove
pressure on a nerve. Vertebroplasty and kyphoplasty are image-guided procedures
performed in an X-ray suite or in an operating room with X-ray equipment.
For a vertebroplasty, the patient is prone (face down) and the procedure
is done either under general anesthesia or under sedation (in which the
patient is awake). One or two needles are advanced under x-ray guidance
into the fractured vertebra through the skin in the back. After the x-ray
confirms good needle placement, the surgeon injects bone cement into the
fractured vertebra. The cement hardens in a few minutes, providing immediate
stability to the bone and relief of pain.
To perform a kyphoplasty, a surgeon first guides a catheter into the vertebra,
then inserts and inflates a small balloon. The balloon creates a cavity
as it inflates; the balloon is then deflated and withdrawn from the vertebra.
In the next step, the surgeon inserts a needle into the catheter to deliver
bone cement into the cavity. The cement hardens in place, providing immediate
stability to the bone.
Kyphoplasty, also referred to as “balloon vertebroplasty,”
is similar to vertebroplasty, but (as its name suggests) uses a balloon.
The balloon is guided through the needle into the vertebra and inflated
in order to correct the abnormal wedging of the broken vertebra. Once
the bones are in the correct position, the balloon is deflated and removed,
and the large cavity created is filled with bone cement. The cement hardens
in place, providing immediate stability to the bone.
The spine surgeons at the Weill Cornell Brain and Spine Center are fortunate
to be part of the NewYork-Presbyterian Hospital team (see
Doctors Who Treat Spinal Compression Fractures). The 2013-14 "America's Best Hospitals" ranking in
US News and World Report placed NewYork-Presbyterian as the #1 hospital in New York, and our Neurology
and Neurosurgery program ranks as the #1 program in New York (and #3 nationwide).
Together, the NewYork-Presbyterian/Weill Cornell Medical Center team is
the best choice for your back.
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