Compression Fractures

What you need to know

During the aging process, the bones in the body begin to thin and weaken. This condition is called osteoporosis. Small micro fractures occur in the weakened bone, which eventually add up and cause the vertebra to collapse. This is called an insufficiency compression fracture .

Women over the age of 50 are susceptible to these issues from menopause. The decreased estrogen causes increased breakdown of the bony tissue, making the bones extremely brittle unable to support the weight of the spinal column. Caucasion and Asian women, thin women, and smokers are at increased risk.

The majority of compression fractures compress the front of the vertebra and instead of maintaining a square shape, create a wedge shape vertebra. If a patient sustains enough of them, their posture changes to being severely stooped and they develop kyphosis or gibbus deformity. This is called a Dowager’s hump.

Patients are usually first diagnosed by performing plain x rays which show collapse of the vertebra. The acuity is usually demonstrated by performing a MRI which also can show if any bone is pushed into the back of the spinal canal compressing the spinal cord or any nerves. A CT scan can be performed in the event an MRI cannot be obtained.

Patients who sustain these injuries are usually recommended to undergo a bone density test to assess the severity of the osteoporosis. They are further encouraged to begin bisphosphonate therapy which can be administered by mouth (actonel, fosamax, boniva) or intravenously.

Acute fractures can be treated with various braces such as a thoracolumbar orthosis (TLSO) and analgesics to decrease the symptoms. Patients who fail conservative care for the first 6-8 weeks may become candidates for a minimal invasive vertebral body augmentation, ie, kyphoplasty.

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Kyphoplasty

During a kyphoplasty, the patient is put under local or general anesthesia. The surgeon makes a small incision in the back and places a narrow tube, then uses fluoroscopy to guide it into the fractured area through the pedicle of the vertebrae. Next, using X-ray images, the surgeon inserts a special balloon through that tube, and inflates it. It elevates the fracture and creates a cavity in the soft inner bone of the vertebrae. When the balloon is removed, the surgeon fills the cavity with polymethylmethacrylate (PMMA – a cement-like material). The PMMA stabilizes the bone.
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Open Decompression & Fusion

In the event of severe compression fractures, whereby the bony tissue is pushed back into the spinal canal and squeezes the spinal nerves to cause neurological weakness, a different approach is considered. Usually, an open decompression and fusion is performed.

During an open decompression, a small section of the lamina (the bony roof of the spine) is removed to make more space for the nerves. This also widens the canal and relieves pressure on the spinal cord. This procedure may also require fusing the spinal column if the decompression causes spinal instability.

Patrick J. Horan, MD, MBA, FACS

Patrick J. Horan is an orthopaedic surgeon and sports medicine specialist with two decades of experience. He is board-certified in orthopaedic surgery and sports medicine. After receiving his undergraduate degree from Duke University in Durham, N.C., Dr. Horan earned his medical degree from Tufts University School of Medicine in Boston. Residency and Internship were both completed at Walter Reed Army Medical Center in Washington, D.C. He also received an MBA from Auburn University in Auburn, Ala.

Dr. Horan served 10 years on active duty in the US Army as an orthopaedic surgeon before entering into private practice. Dr. Horan is the founder of the Westchase Orthopaedic and Rehabilitation and the official surgeon of the Tampa Bay Rowdies. He maintains professional memberships with the American Academy of Orthopaedic Surgeons, the American Academy of Orthopaedic Sports Medicine and the Arthroscopy Association of North America.

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Dr Horan has done a few of my knee surgeries and has always been the best surgeon. Dr Lao has been my physical therapist for every knee surgery and his results are proven and outstanding. I’d be in bad shape if it wasn’t for dr Lao and his staff who go above and beyond to do what’s needed.

Testimonials

Dr. Lao is simply the best! His intense educational training and specialty of the spine are something that you seldom come across these days. When I lived in Bradenton for 9 months I would drive over an hour just to see him because he was the only one I trusted with my physical issues. His assistant Sam is wonderful and Lisa at the front desk is always very helpful! There is another PT there that I have not treated with, but I only hear great things about him! 🙂 I will not go anywhere else.

Testimonials

This review encompasses both Dr Horan's orthopaedic side of the business & Dr Lao's physical therapy side. I have no idea if their practices are actually related, but there's only one street sign & only one Yelp check-in. Luckily, I think both doctors are excellent.

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