In this week's episode of the Spine & Nerve podcast, Dr. Nicolas Karvelas and Dr. Brian Joves discuss vertebral compression fractures with an emphasis on osteoporotic compression fractures.  

Compression fractures, as the name suggests, are when the bones of the spine fracture and break because the force placed on the spine overcomes the internal strength of the bones. In a young healthy individual this can be seen in trauma, but as three population ages we are seeing this occur not in noon traumatic circumstances- we tend to refer to those as osteoporotic fractures.

Osteoporotic vertebral compression fractures are a common medical problem with an estimated prevalence of around 30% in the elderly population over 65 years old.  The consequences of a compression fracture is not limited to significant back pain which can be very debilitating, but there is also increased risk of adjacent spinal fractures in the setting of the vertebral deformity and altered biomechanics, and increased mortality both in the short and long term.  As the population over age 65 continues to grow, the medical community will continue to work to optimize the guidelines for diagnosis and treatment of this medical problem.  

 

Work remains to be done to optimize guidelines, but currently from a diagnostic standpoint, the American College of Radiology does recommend Xrays, DEXA scan, MRI and/or CT for diagnosis.  Once the diagnosis is made the treatment depends on multiple factors including the acuity of the injury.  For severely symptomatic acute compression fractures Vertebroplasty and Kyphoplasty are strong considerations and are on the clinical guideline recommendations for the American College of Radiology and the National Institute for Health and Care Excellence Guidelines.  Especially as the pathology becomes more chronic, stronger consideration may be given to targeting the medial branches of the affected facet joints as a therapeutic target.  Treating the medial branches will positively modulate the pain from the joints affected by the altered biomechanics of the compromised vertebral body.  One of the major benefits of consideration of treating the facet joints themselves to manage the pain associated with vertebral compression fracture (especially more subacute to chronic fractures) is that we can achieve good pain relief with significantly lower risk to the patient.

Listen in as the doctors discuss this recent literature and practical ways to approach this challenging issue.

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This podcast is for information and educational purposes only, it is not meant to be medical advice. If anything discussed may pertain to you, please seek council with your healthcare provider. The views expressed are those of the individuals expressing them, they may not represent the views of Spine & Nerve.