Treatments such as Vertebroplasty and Kyphoplasty have quickly become the treatment of choice for unbearable back pain as a result of compression fractures. These procedures, performed under x-ray guidance, utilize thin needles to access fractured vertebral bodies to allow for the injection of bone cement to stabilize fractures. In many of these cases balloons can be used to reduce the fracture into a more anatomic alignment, subsequently reducing kyphosis. Both of these procedures have been shown to result in a greater than 90% symptomatic improvement within the first 24 hours.
Patient selection is the critical factor in determining who will have a successful procedure. The right patient has a painful osteoporotic, post traumatic, or pathologic compression fracture refractory to conservative therapy that alters and limits daily activity. The patient has no significant systemic infection or an uncorrected coagulopathy. Preprocedural imaging using xray can be used to identify a new compression fracture but advanced imaging such as MRI or Nuclear Medicine Bone Scan is needed to determine whether the fracture is healed, particularly in the setting of multiple fractures. Physical examination under fluoroscopy by the doctor doing the procedure is necessary to determine if the fracture is the cause of the patient's back pain.