Surgery for vertebral fractures

Vertebral fractures tend to be more common in elderly people with bone atrophy (osteoporosis). They are less commonly caused by accidents or bone metastases due to cancer. Modern surgical treatment for vertebral fractures due to osteoporosis involves the use of bone cement to stabilise and rebuild the broken vertebra. Vertebrae broken in accidents are often treated with osteosynthesis procedures.

In humans, bone is lost increasingly from the age of 40. This process is referred to as bone atrophy or osteoporosis. One of the factors that triggers this process is the hormonal changes that occur in menopause. Osteoporosis, therefore, is much more common in women than in men.

Loss of vertebral bone can cause the vertebrae to break even when little weight is put on them and result in pain and damaged posture.

Osteoporotic vertebral fractures and vertebral fractures following accidents or due to bone metastases can be treated nowadays with the application of bone cement. This minimally invasive procedure is referred to as vertobroplasty or kyphoplasty.

What preparations are carried out before the procedure?

Prior to the procedure, the extent of the osteoporosis and vertebral fracture is determined based on x-ray images and, where applicable, CT scans.

In most cases, the procedure is performed under local anaesthesia. There is therefore no need to prepare for general anaesthesia.

How is the operation performed?

Vertebroplasty or kyphoplasty requires only small incisions to be made above the affected vertebra. A hollow needle is inserted through these incisions with x-ray guidance as far as the affected vertebra. Bone cement is then injected under high pressure through the hollow needle into the vertebra. The liquid bone cement distributes evenly in the broken vertebra and hardens in a short space of time. This rebuilds and strengthens the vertebra damaged by osteoporosis. A synthetic material made of polymethyl metacrylate is used for the cement. In young patients, a biodegradable form of cement is used, as in most cases the young body can form bone again itself.

Vertebral fractures following accidents are often treated with [osteosynthesis procedures]. This involves the use of screws and plates to fix the broken vertebrae in place. This procedure, which leads to a partial stiffening of the spine, is known as spondylodesis or internal fixation.

What is the success rate of this procedure?

Strengthening and stabilisation of the vertebra can in general result in a marked improvement in symptoms such as pain and restricted mobility. However, the procedure does not treat the bone atrophy itself, which is the root cause of all the problems in osteoporotic fractures.

What are the possible complications and risks of this procedure?

Vertebroplasty or kyphoplasty has now become a low-risk routine procedure. As with all surgery, the operation may occasionally lead to infections, nerve damage, post-operative haemorrhaging or blood clots. In rare cases, small amounts of bone cement may enter the surrounding tissue, causing irritation or nerve inflammation.

What happens after the operation?

As bone cement quickly hardens, the spine can support full weight again on the same day. There will be a follow-up after 4 to 6 weeks. In osteoporotic fractures, it is essential to continue osteoporosis treatment. This includes physiotherapy with exercises and muscle training as well as medication to treat the bone atrophy.

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