Vertebral augmentation for spinal osteoporosis

Osteoporosis is a condition that comes on gradually over a number of years. It is preceded by a condition called osteopenia which occurs when your bones are weaker than they should be, but you do not yet have osteoporosis. If you are diagnosed with osteopenia, there's a good chance you can prevent osteoporosis from developing with lifestyle changes and supplements.

Spinal osteoporosis doesn't usually cause any symptoms in the early stages and many people are unaware that they have it. Most people don't experience symptoms until they have a spinal compression fracture.

Symptoms of spinal osteoporosis and spinal compression fracture include:

• Sudden severe back pain at the time the fracture occurs
• Chronic (ongoing) back pain as the fracture heals
• Difficulty walking, sitting for long periods, and lifting objects
• Loss of height
• A stooping posture with a curved back
• Difficulty bending or twisting your body

Fractures in the lower spine are usually more painful and cause more problems with movement than fractures in the upper spine. It's possible to have more than one spinal compression fracture at the same time.

You are more likely to develop spinal osteoporosis if you:

• Are female, particularly after the menopause
• Are older - osteoporosis risk increases with age
• Have a family history of osteoporosis
• Have hormonal imbalances such as low oestrogen levels or an overactive thyroid
• Take medications such as steroids, anti-seizure medications, anti-rejection drugs, or medications for gastric reflux
• Take medications that affect bone strength or hormone levels such as treatment for breast cancer
• Have a chronic medical condition like celiac disease, inflammatory bowel disease, cancer, or rheumatoid arthritis
• Have a low body mass index (BMI)
• Have or have ever had an eating disorder such as anorexia nervosa, or bulimia
• Don't exercise regularly
• Smoke
• Drink excessive amounts of alcohol

At your first consultation, you will be seen by a spinal or orthopaedic surgeon. Your consultant will ask you about your medical history and symptoms and perform a physical examination.

Your consultant will typically order tests or scans to make or confirm a diagnosis. These may include:

• X-ray - to check your spine for fractures
• Computerised tomography (CT) scan - to check the bones of your spine in more detail
• Magnetic resonance imaging (MRI)- may be used to check for soft tissue injuries around the fractures
• Bone density scan (dual X-ray absorptiometry or DEXA scan) - this measures how dense or strong your bones are and is the best way to diagnose osteoporosis

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it's where we get to know you and learn about your individual case, symptoms, and expectations for treatment.

Your first appointment is where you meet your consultant, learn about your diagnosis, and discuss possible treatment options.

It is important to us that you are as well-informed and comfortable as possible before, during, and after your treatment, so please ask your consultant any questions you may have.

After making a diagnosis, your consultant will discuss possible treatment plans with you and decide on the best option based on your diagnosis, individual circumstances, and expectations for treatment.

Treatment for spinal osteoporosis can be non-surgical or surgical. Non-surgical treatments for spinal osteoporosis fractures include:

• Rest
• Pain medications
• Wearing a back brace to support the spine as it heals
• Physiotherapy
• Treatment of your osteoporosis with medications to prevent further fractures
• Lifestyle changes like eating a healthy, balanced diet, taking regular exercise, and stopping smoking

Surgery to treat spinal fractures caused by osteoporosis is known as vertebral augmentation. This treatment may be considered if your back pain is severe, or if other non-surgical treatments haven't worked.

Vertebral augmentation is a minimally invasive procedure meaning there is no large incision (cut) and there will be minimal damage to your body.

It involves injecting a type of medical 'cement' into the fractured vertebrae through a needle inserted into your skin. The hot cement stabilises the vertebra and also burns off many nerve endings, which helps to reduce pain.

The procedure is performed by a specialist orthopaedic, spinal, or radiology consultant and may be done under local anaesthetic with sedation, or general anaesthetic. The type of anaesthetic you have depends on the type of procedure, the number of vertebrae being treated, and your and your consultant's preferences.

Before your procedure, your consultant will explain everything you need to do to prepare for your vertebral augmentation operation.

Make sure you tell your consultant about any medical conditions and allergies you have as well as any medications you are taking. If you take blood thinners like warfarin or aspirin, your consultant may tell you to stop taking these for a few days before your procedure.

Depending on the type of anaesthetic you have, you may need to stop eating and drinking for a few hours before your vertebral augmentation.

There are two types of vertebral augmentation procedures:

• Vertebroplasty - a hollow needle is used to inject the fractured vertebra with cement
• Kyphoplasty - a balloon is inserted and inflated to expand the collapsed vertebra before injecting the space with cement

Vertebral augmentation may be different for everyone, and your procedure may vary depending on your individual situation, how many vertebrae are being treated, and your consultant’s preferences. Talk to your consultant about what will happen during your procedure.

What happens during a vertebral augmentation operation?

Before the procedure, you will have a cannula (a small plastic tube) inserted into your hand. You will be given sedation or general anaesthetic through this cannula.

After your consultant has washed their hands and put on a surgical gown, mask, hat, and sterile gloves, the area to be operated on is cleaned with an antiseptic solution.

You will be positioned on your stomach for the procedure.

First, local anaesthetic is injected to numb the area. When the anaesthetic has taken effect, your surgeon will make a small incision over the fractured vertebra.

Image guidance called a fluoroscope (a type of X-ray) is used to guide the surgeon throughout the procedure. This allows your consultant to see where the needles are positioned and how far they need to be inserted.

During a kyphoplasty, a balloon is inserted into the collapsed space within the vertebra. The balloon is expanded to restore the collapsed vertebra to its full height before being deflated and withdrawn. Bone cement is injected slowly into the collapsed vertebra. After the needles are withdrawn, the incision is closed with steri-strips (thin, adhesive bandages) or glue, and a sterile dressing is applied.

Vertebral augmentation normally takes around an hour depending on the number of vertebrae being treated.

After your vertebral augmentation, you will be taken to the recovery room. You may need to lie on your back for up to an hour while the cement hardens. After an hour you will be able to sit up, and you will be able to walk after about two hours.

How many nights will I have to spend in hospital?

Most people can go home the same day after vertebral augmentation, but in some cases, your consultant may want you to stay in hospital for one night. Talk to your consultant about when you can expect to go home after your procedure.

Can I drive myself home from hospital?

You will not be able to drive yourself home from the hospital, so make arrangements for someone to come and collect you after your procedure. We can arrange a taxi for you if you prefer.

How soon can I go back to work?

How soon you can go back to work depends on your recovery and the type of job you do. You should avoid any strenuous activity or heavy lifting for up to six weeks after your procedure. Talk to your consultant about when you can expect to go back to work after your vertebral augmentation.

How soon can I drive?

Don't drive for at least two to three days after your procedure. After this, if your pain is well controlled, you should be safe to drive. Ask your consultant about when you can expect to drive after your procedure.

When will I be back to normal?

You will need someone to help you for a day or two after your procedure. After this, you should be able to carry out light tasks.

You may have some pain in your back for a few days after your surgery. Take the pain medication your consultant prescribed as directed. Applying ice packs to the area for five to ten minutes a few times a day can help relieve pain and swelling. Always wrap ice or ice packs in a cloth and never apply ice directly to your skin.

You will need to keep your dressing dry for 48 hours after your surgery.

After the first couple of days, you should be able to gradually increase your level of activity. You may need to avoid heavy lifting or strenuous activity for up to six weeks after your surgery.

Your consultant will arrange a follow-up appointment for you about two weeks after your surgery. Until your follow-up appointment:

• Avoid lifting anything heavier than about five pounds (2.2 kg)
• Avoid bending, or twisting your back
• Avoid alcohol - this can increase the risk of bleeding
• Avoid strenuous activities such as housework, gardening, exercise, and sex
• Take any pain medications as directed by your consultant
• Walk for around five to ten minutes every three to four hours. Increase this amount gradually as you are able

At your follow-up appointment, your consultant will review your progress and recovery. Ask your consultant any questions you may have about your recovery and when you can expect to return to normal activities during this follow-up appointment.

Surgical outcomes

Vertebral augmentation is a safe and effective procedure for vertebral fractures caused by osteoporosis. Most patients experience relief of back pain within 24 to 48 hours of surgery and a significant improvement in pain, function, ability to carry out self-care tasks, quality of life, and deformity.¹

Vertebral augmentation is a minimally invasive procedure that is normally very safe but, as with any surgery, there is a small risk of complications. Your consultant will explain all the possible risks and complications of surgery before your procedure, and answer any questions you may have, allowing you to make an informed decision.

General risks of surgery include:

• Bleeding
• Infection
• Adverse reactions to anaesthetic
• Blood clots
• Shock
• Chest problems
• Problems passing urine (urinary retention)

Possible risks and complications of vertebral augmentation include:

• Cement leakage - this may occur when the cement leaks outside the compression fracture. This doesn't usually cause any problems, but in some cases, the cement may leak onto a nerve or the spinal cord which can cause pain, tingling, numbness, weakness, or loss of movement.
• Nerve damage - as the procedure takes place near the spinal cord, there is a small risk of damage to the nerves and spinal cord
• Failure to reduce pain - in some cases vertebral augmentation may not be effective in relieving or reducing pain
• Bone necrosis - death of bone tissue is a rare complication of vertebral augmentation
• Pulmonary embolism (a blood clot on the lungs) - this is rare but may occur when cement leaks out of the vertebra and travels through the bloodstream to the lungs

We answer some of your most frequently asked questions about spinal osteoporosis.

Can osteoporosis cause spinal stenosis?

Spinal stenosis is a condition where the spinal canal (the space inside the vertebrae) is too narrow. It is caused by damage to the spine that may include compression fractures caused by osteoporosis.

Can you have a spinal fusion if you have osteoporosis?

Spinal fusion surgery is normally performed for vertebral fractures caused by an accident or injury. For patients with osteoporosis, vertebral augmentation is recommended as it is a less invasive procedure with fewer risks of complications.

Does spinal osteoporosis shorten your life?

Though osteoporosis doesn't shorten your life, vertebral compression fractures caused by spinal osteoporosis can. Research shows that people with compression fractures of the spine die earlier than people of the same age without compression fractures.²

Is spinal osteoporosis painful?

Osteoporosis is not usually painful until a fracture occurs. If you fracture your vertebra, you may feel a sharp pain in your back or neck at the time it occurs. This is commonly followed by a dull, ongoing pain as the vertebra heals.

What exercises can I do with osteoporosis?

If you have been diagnosed with osteoporosis, there are some exercises you can do to improve bone strength and help manage your condition. These include:

• Walking
• Resistance training with bands or free weights
• Swimming
• Cycling
• Exercises to improve your posture

Always talk to your doctor or healthcare provider before starting any exercise regime. Start slowly, build up and stop immediately if you feel any pain.

If you have osteoporosis, you should avoid high-impact exercise, exercise with a high risk of falls, and exercises that involve bending or twisting including:

• Running
• Jumping
• Sit-ups
• Touching your toes
• Some yoga and Pilates poses
• Golf and tennis
• Skiing

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant best suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about vertebral augmentation surgery, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Osteoporosis, NHS
2. Osteoporosis and Spinal Fractures, OrthoInfo
3. Osteoporosis and the Management of Spinal Degenerative Disease, PubMed
4. Osteoporosis Causes, Risk Factors, Complications, Diagnosis, and Treatment, Spine Universe
5. Life Expectancy in Patients Treated for Osteoporosis: Observational Cohort Study Using National Danish Prescription Data, PubMed 
6. Review of Vertebral Augmentation: An Updated Meta-analysis of the Effectiveness, PubMed