Mr Ben Okafor FRCS (Orth.)

Consultant Orthopaedic and Spinal Surgeon

Spinal fractures - from osteoporosis, multiple myeloma and metastatic disease

Bone, the framework of the body, is made mostly of collagen (a type of protein) and a mineral called calcium phosphate. Bone is a living tissue, continually replacing itself through a process of new bone growth (formation) and old bone removal (resorption).

During childhood and teenage years, formation occurs faster than resorption. As a result, bones become larger, denser and heavier. Then, at about age 30, resorption slowly begins to exceed formation, reducing bone mass by about 1% each year. Events such as menopause can trigger rapid bone loss. There are many other risk factors that affect bone loss; most of which can be controlled.

What is osteoporosis?

In osteoporosis, bone (osteo) becomes porous (porosis). As a result, bones are weakened and made brittle, becoming prone to fractures. Often referred to as a "silent disease", osteoporosis may have no symptoms until a painful fracture occurs. When the osteoporosis occurs in the vertebrae of the spine, the vertebrae may collapse.

This results in severe back pain, nerve pain or dysfunction, loss of height, or spinal deformities such as kyphosis (severely stooped posture).

What causes osteoporosis?

Poor nutrition or lack of exercise during the bone-forming years can result in bones that are less dense than they should be. Bones that are less dense are more likely to be affected by osteoporosis. Smoking, excessive use of alcohol, lack of exercise and poor nutrition during adulthood can cause bones to lose density.

Women with smaller, thinner bones are more prone to osteoporosis and are also adversely affected by hormonal changes. Heredity and ethnicity may also affect the chance of developing osteoporosis. Secondary osteoporosis results from other health conditions, such as hormone imbalances, arthritis and joint disease, certain medications such as steroids, and some diseases or treatments of the digestive system.

Can osteoporosis be prevented?

You can prevent or slow down osteoporosis by making healthy life-style choices. Good nutrition, with sufficient amounts of calcium and vitamin D are necessary for bone growth. Bones are living tissue and become stronger with exercise.

Weight-bearing exercises, done consistently, make bones stronger. These exercises may include walking, stair-climbing, dancing, and tennis. Weightlifting, even if done with small weights, is beneficial. Swimming and water exercises are useful for people who can't otherwise bear weight. Not smoking and avoiding alcohol consumption reduce bone loss. Regular consumption of just 2 to 3 ounces of alcohol may be damaging to the skeleton, even in young adults.

What are the treatment options for spinal fractures due to osteoporosis?

Spinal fractures that result from osteoporosis can be surgically treated, depending on the location of the fracture. Hip fractures should be treated with reconstructive surgery within 48 hours, if possible. Spinal fractures can be repaired using procedures called kyphoplasty and percutaneous vertebroplasty.


Kyphoplasty is a type of vertebroplasty in which the vertebral body is first prepared for the cement by using a balloon to inflate and reposition the vertebra. As the cement hardens, the vertebral body may resume a more normal shape. Kyphoplasty is minimally invasive, requiring only a very small incision in the back. A narrow tube is inserted through the incision using fluoroscopy to guide it into the correct position in the damaged vertebrae. Using the tube as a channel, the doctor then guides a special balloon into the vertebral body. The balloon is then carefully inflated, restoring the vertebrae to a more normal shape. It also creates a cavity in the vertebral body by compacting the soft inner bone material.

The balloon is then deflated and gently removed. Special instruments are used to fill the cavity with a soft cement-like material which quickly hardens to stabilize the vertebrae.

With the vertebrae shape and height restored, the pressure on the nerves is reduced, easing the pain.

Percutaneous vertebroplasty

Percutaneous vertebroplasty uses an epoxy cement injected into fractured vertebrae. The epoxy becomes rock-hard within minutes, yet is light and supportive. The vertebrae must be treated before total collapse. Percutaneous vertebroplasty does not necessarily restore the physiological shape of the vertebra, but does reduce further disintegration. Other injectable bone-mineral substitutes that are similar to normal bone are being tested. Percutaneous techniques (performed through the skin) derive their origins and continued success from medical advances and patients' desire for a less invasive yet effective therapy. The procedure uses a local anesthetic and the patient is able to walk around within a day.

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Pre-operative xray of spinal fracture

How the patient is positioned for kyphoplasty


Interoperative xray

Reduction of the fracture

Post-operative xray showing repair of fracture

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