Surgery for Spine Compression Fractures

If a spine compression fracture causes significant back pain that persists for more than two months despite nonsurgical treatment such as pain medication, activity modification, and bracing, doctors may recommend surgery to relieve pain and stabilize the spine.

At NYU Langone, orthopaedic surgeons and neurosurgeons who have specialized training in spine surgery offer minimally invasive outpatient procedures that rapidly relieve back pain and provide long-lasting stability in the spine. These procedures are performed using either regional or general anesthesia, a decision you and your doctor make together before surgery.

Minimally invasive surgery can often stabilize a fracture. However, open surgery may be the best option if a fractured bone puts pressure on the spinal cord or nerves that travel through the spinal canal. It may also be recommended if a compression fracture leads to unusual movement between the bones of the spine, reducing stability.

Kyphoplasty

In this procedure, a surgeon inserts a cannula—a thin metal tube—into the collapsed vertebra. A live X-ray video is used to guide the insertion of the cannula into the affected vertebra with extreme precision. 

After the cannula is in position, the surgeon passes a small balloon through the cannula and into the fractured vertebra. It is then gently inflated, creating an empty cavity. The balloon lessens the loss of height from the injury and reduces the deformity from the fracture.

The surgeon deflates and removes the balloon, injecting into the empty cavity a soft, cement-like material through the cannula. The cement hardens very quickly.

During a kyphoplasty, surgeons often take a sample of the vertebra for a biopsy. This additional testing can give more details about why the bone didn’t heal on its own. In an office visit after surgery, your doctor reviews the results with you.

Vertebroplasty

Vertebroplasty is very similar to kyphoplasty, except a balloon is not used to create an empty cavity within the vertebral space. The surgeon inserts the cannula into the vertebra, using a live X-ray image to guide its placement, and injects the soft cement-like material directly into the vertebral fracture. This cement also hardens quickly, eliminating painful movement of the fractured bone.

Open Surgery

Open surgery enables a surgeon to have direct access to the spine through an incision. A surgeon may recommend open surgery to relieve pressure on the nerves or the spinal cord, both of which pass through the spinal canal formed by the stacked vertebrae. This procedure is called decompression. 

If a compression fracture compromises the stability of the spinal bones surrounding the fracture, a surgeon may perform spinal fusion to permanently join two or more vertebrae together to eliminate movement between them. 

Our spine surgeons use general anesthesia for these procedures. They determine the appropriate technique based on your symptoms and the results of diagnostic tests. In some instances, decompression and spinal fusion may be performed at the same time.

What to Expect After Surgery

Recovery from kyphoplasty or vertebroplasty is minimal. Most people are able to walk on their own and return home hours after surgery. The incision surgeons make to insert the cannula is so small that stitches are often not required. Postoperative pain is typically managed using over-the-counter pain relief medication. 

Most people are fully recovered and free of back pain in five days. Our doctors recommend that physical therapy start two weeks after surgery for people with reduced muscle tone due to lessened physical activity before surgery.

At a follow-up appointment two weeks after surgery, your doctor examines the spine, perhaps using X-rays to inspect the cement. At this time, most people feel well enough to return to everyday activities, including a regular exercise routine.

After open surgery, people usually remain in the hospital for a few days for observation. Our pain management specialists are available 24 hours a day to ensure you remain comfortable while you recover. Many people are able to walk on the day of surgery, though this depends on age, the extent of surgery, and the severity of postoperative pain.

After going home from the hospital, you may wear a back or neck brace for a few weeks to provide additional stability while the spine heals. In the weeks after surgery, a physical therapist can create a plan to help you build strength and flexibility in the muscles surrounding the spine, so you can return to your usual activities as soon as possible.

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