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Compression Fracture Treatment: The Importance of Biopsy

  November 01, 2018
By Megan Finneran, DO, Neurosurgical Resident

Back pain is one of the leading causes of patients seeking care in a physician office or emergency room. One of the major reasons people have back pain is vertebral body fractures. One type of fracture is a compression fracture, which affects about 700,000 patients each year.

They are most common in elderly women and may occur from severe trauma like a car accident or from moderate trauma like a fall. In some patients, an underlying problem such as osteoporosis or a tumor may cause weakening of the bone, making it easier to fracture. In one study of vertebral body fractures, 14 percent followed severe trauma, 83 percent followed moderate or no trauma, and 3 percent were due to underlying malignancy, or cancer.

Maybe you or a loved one has some of the risk factors associated with osteoporosis or compression fractures. These include low BMI, lack of weight-bearing exercise, low calcium intake, low vitamin D, chronic steroid use, smoking, and excessive alcohol intake.

Typical presentation
The most common symptom of a compression fracture is back pain in the center of the back at the level of the fracture, although many people may have a vertebral body fracture they are not even aware of. Sometimes your doctor may pick up a fracture on imaging you had done for another reason. Often if a fracture is seen, your doctor may request a CT scan and/or MRI to better define the fracture and the right treatment plan for you.

Treatment options
Most of the time, compression fractures require no treatment at all. The fracture may improve over time with a brace specially fitted to your body to help your spine heal on its own. If you have osteoporosis that contributed to your fracture, drugs to strengthen the bones may be prescribed. The pain that comes with these fractures will typically improve over time with medications such as Tylenol and Ibuprofen.

However, if you are suffering severe pain and conservative treatment is not working, your doctor may present you with two main options: vertebroplasty and kyphoplasty. The goals of both procedures are to improve pain and prevent worsening of the fracture. One major advantage of these surgeries is they allow your doctor to take a biopsy from the bone to ensure you do not have an underlying problem like a cancer that contributed to the fracture.

Procedure
If you have a vertebral body fracture and the pain is unbearable, here is what you need to consider. Both vertebroplasty and kyphoplasty involve injecting cement, typically polymethylmethacrylate, into the fracture with the goal of providing structural support to the bone and restoring the height of the bone that may have collapsed. For vertebroplasty, a small tube is inserted into the spine while two x-ray machines specially positioned allow the surgeon to have live images of the needle’s progress to ensure proper position, at which point the cement is injected. For kyphoplasty, one additional step involves a balloon that is inflated into the fracture to expand it in order to open a space for the cement. The balloon also allows a more immediate fix of the vertebral body height.

It is important to remember that in some cases, when a fracture is more complex, you may need a consultation with a surgeon to discuss a more advanced surgery.

Biopsy
Osteoporosis is the most common cause of weakening of the bone, but spinal tumors are another cause. The most common malignant tumors seen with compression fractures are from multiple myeloma and metastasis from cancer somewhere else in the body. For this reason, some surgeons recommend biopsy with all vertebroplasties and kyphoplasties to test for a possible malignancy. Worldwide, the percent of patients with an unknown malignancy that was discovered from kyphoplasty or vertebroplasty biopsy ranges from approximately 0.4 percent to 7.1 percent, and the number is even higher for patients with a history of cancer.

Among neurosurgeons here in Bloomington at Central Illinois Neuro Health Sciences, the rate is about four percent. That means for every 100 patients who have a kyphoplasty or vertebroplasty, four of them learn they have a cancer they did not know about before their biopsy. You or someone you love could be one of those four. When considering a vertebroplasty or kyphoplasty, it is not just injecting cement. Very careful consideration needs to be given to considering a biopsy.

Central Illinois Neuro Health Sciences is located at 1015 S. Mercer Ave. in Bloomington. For more information or to schedule a consultation, you may contact them at 309-662-7500 or through their website, www.cinhs.com.
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November 01, 2018

 

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