TREATMENTS & PROCEDURES
VERTEBRAL COMPRESSION FRACTURES
The main clinical symptoms of VCFs may include any of the following, alone or in combination:
- Sudden onset of back pain
An increase in pain intensity while standing or walking
A decrease in pain intensity while lying on the back
Limited spinal mobility
Eventual height loss
Eventual deformity and disability
Complications related to VCFs include:
- Segmental Instability
- Neurological Complications
While a diagnosis can usually be made through history and a physical examination, plain x-rays, computed tomography or magnetic resonance imaging, can help in confirming the diagnosis, predicting prognosis, and determining the best treatment option for the patient.
X-ray: An x-ray is the application of radiation to produce a film or picture of a part of the body that can show the structure of the vertebrae and the outline of the joints. It will also show bone alignment, disc degeneration, and bony spurs which may irritate nerve roots.
Computed tomography scan (CT or CAT scan): A diagnostic image created after a computer reads x-rays; it can show the shape and size of the spinal canal, its contents, and the structures around it. This test may be performed in conjunction with a myelogram of the spine to provide additional information. This diagnostic study is ideal for showing bone detail including stenosis.
Magnetic resonance imaging (MRI): A diagnostic test that produces three-dimensional images of body structures using powerful magnets and computer technology; can show the spinal cord, nerve roots, and surrounding areas, as well as enlargement, degeneration, and tumors.
Dual-energy x-ray absorptiometry (DXA or DEXA) or bone densitometry: This test is the established standard for measuring bone mineral density and can determine if osteoporosis exists. The scanner painlessly and rapidly directs x-ray energy from two different sources towards the bone being examined in an alternating fashion at a set frequency. A DEXA scan can detect small changes in bone mass and is also more flexible since it can be used to examine both the spine and the extremities. A scan of the spine, hip or the entire body requires less than four minutes.
Patients with any of the following criteria
should not undergo these procedures:
- A VCF that is completely healed or is responding effectively to conservative therapy
- A VCF that has been present for more than one year
- Greater than 80 to 90 percent collapse of the vertebral body
- Spinal curvature such as scoliosis or kyphosis that is due to causes other than osteoporosis
- Spinal stenosis or herniated discs with nerve or spinal cord compression and loss of neurological function not associated with a VCF
- Untreated coagulopathy (a disease or condition affecting the blood’s ability to coagulate)
- Osteomyelitis (an inflammation of the bone and bone marrow, usually caused by bacterial infection)
- Discitis (nonbacterial inflammation of an intervertebral disc or disc space)
- Significant compromise of the spinal canal caused by impeding bone fragment or tumor
- Complication rates for vertebroplasty and kyphoplasty have been estimated at less than 2 percent for osteoporotic VCFs and up to 10 percent for malignant tumor-related VCFs. The benefits of surgery should always be weighed carefully against its risks. Although a large percentage of patients report significant pain relief after these two procedures, there is no guarantee that surgery will help every individual.
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VERTEBRAL COMPRESSION FRACTURE SPECIALISTS
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