Kyphoplasty Over Natural Healing for Spinal Fractures?

Medical community debating injection with side effects vs. allowing break to heal on its own

A neurosurgeon using a pencil pointing at a lumbar vertebra model in a medical office

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By:

Sonia Narang

En español

Published July 31, 2019

If you've ever tripped or fallen your way into a vertebral fracture, you know the excruciating pain these kinds of breaks in your spine can cause. Unfortunately, these types of compression fractures are also an all-too-common injury, particularly in older women in their 70s and 80s who have osteoporosis or reduced bone mass. In fact, an estimated 750,000 new fractures occur annually in the U.S., according to a 2019 report published by the American Society for Bone and Mineral Research.

An illustration of the process for a kyphoplasty procedure

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In recent years, a newer, minimally invasive procedure called kyphoplasty — which involves a cement injection into the broken vertebra to hold it in place — has become an increasingly popular option for these fractures, one that doctors note is well covered by insurance and Medicare.

During the kyphoplasty, doctors insert a needle into the patient's back and use a balloon to elevate the collapsed vertebra. Then, they inject a special type of cement called polymethyl methacrylate (PMMA) into the broken bone to stabilize it. (A similar, older procedure called vertebroplasty inserts cement without the addition of the space-holding balloon.) Kyphoplasty is a short procedure that can relieve acute pain, and is usually performed within the first two months after the fracture.

However, there's debate in the medical community surrounding its efficacy and usefulness. While some doctors wholeheartedly recommend kyphoplasty, others are more cautious, preferring to avoid a procedure that could have unwanted side effects for a break that will ultimately heal on its own. The lack of studies proving the efficacy of kyphoplasty is another reason doctors give for not offering it; earlier studies on the similar procedure of vertebroplasty did not find it worked well enough to justify offering it to women with osteoporosis.

At the Mayo Clinic in Rochester, Minnesota, radiologist David Kallmes, M.D., takes a middle road that many now tread with regard to kyphoplasty. While he and his team routinely perform the procedure, he advises patients to wait for several weeks to see if the pain improves on its own first.

He also counsels patients that while the procedure can considerably alleviate pain levels — presumably by preventing microscopic motion at the fracture site by stabilizing the bone, it doesn't entirely eliminate it. Before the procedure, he notes, “The average pain severity is typically seven or eight or so. It goes down to about four. It's not zero.”

Kyphoplasty also isn't a slam dunk in terms of restoring back function. “They're not going back to completely normal function,” Kallmes says. And back pain may continue long after the procedure, if at lower levels than before. Some patients also experience new back muscle pain and stiffness, including residual pain in the muscles around the cemented bone.

While kyphoplasty patients can have complications, including cement leakage or spinal cord damage, these are rare.

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The alternative to newer kyphoplasty procedures is good old natural healing, with a period of bed rest from three days to a couple of weeks, followed by avoiding nearly all physical activity for many weeks thereafter — all in order to immobilize the back to allow the broken vertebral bone to heal. Doctors also advise wearing a brace to restrict movement, along with taking often high doses of pain medication.

"A lot of people say, ‘Oh, how can you not treat a spinal fracture?'” Kallmes says. “But, really putting someone on bed rest is like putting an arm in a sling for a fracture of the arm.”

That said, natural healing has its drawbacks, too, which include possible negative effects of pain medication and the loss of muscle or function that comes with so much time spent not moving. Doctors also report that patients find braces highly uncomfortable.

If you've fractured a vertebra, whether you've chosen natural healing or kyphoplasty, the risk for future spinal compression remains high. Some studies suggest the hardened bone cement injected during a kyphoplasty increases the strain on adjacent vertebrae, leading to an even higher fracture risk.

As a result, following any vertebral fracture treatment, Kallmes says that “being treated for their osteoporosis, that's the absolute, number 1 most important thing."

While you'll need to see a doctor to do so, such treatment often involves upping your calcium intake through diet or supplements, and, possibly, going on medication to slow bone loss. Specific exercise to build bone and strengthen muscles involved in balance (while protecting the site of any previous fracture) is also key.

Another simple, yet effective way to prevent subsequent spinal fractures? Avoid bending, especially to pick up or lift something. “Every time you bend forward, there's more pressure put on the front part of the bones [in the spine],” notes Matthew Drake, M.D., an endocrinologist with the Mayo Clinic. “If you have enough of that pressure and you have a bone that's not as strong, that vertebra can basically just crush a little bit.”

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