What's the time limit on fixing fractures?

I am amazed at the number of times this question comes up. I hear it from patients, I hear it from family doctors. I even hear it from experienced spine surgeons.

The answer is simple enough. There is no time limit on fixing vertebral compression fractures. Even if the fracture is 20 years old or older, as long as a patient has back pain and your physician thinks that pain is from the fracture, it will almost always respond to therapy.

In the medical literature, older fractures have documented success. In one study that looked at patients with chronic fractures, 70% of them got essentially complete pain relief from vertebroplasty. In my experience, the success rate is even higher.

The more significant question to ask is this. If a patient has back pain and has a fracture, why wouldn't the doctor treat it using proven therapy such as vertebroplasty? It certainly costs a lot less than having surgery. Unfixed vertebral compression fractures are a known cause of so-called failed back surgery syndrome (post-laminectomy syndrome). Unfortunately, this is a fact lost on a lot of spine surgeons, as I continue to see patients get fusions for these fractures when vertebroplasty is more effective.

Cervical Kyphoplasty

There are very few doctors who perform vertebroplasty or kyphoplasty in the upper thoracic or cervical spine. Luckily for our patients, we do.

This is a rotary kyphoplasty we performed today at the C7 vertebral body. This patient had suffered from the pain for over 7 years. It's another key example of a fracture that a radiologist called "old" or chronic, yet responds to treatment.

Due to potentially life-threatening complications, cervical fracture fixation is not to be taken lightly and should only be performed by experienced doctors. Although there are about 20 doctors in our area who have trained to fix fractures, only one or two of us perform them in the cervical spine. Who would you rather have fixing a fracture in your loved one?

When Osteoporosis Affects Men

The Tulsa World published an article on 3/6/2008 about one of our patients. He was a typical male patient who suffered a vertebral compression fracture.


For ill or good, osteoporosis is often thought of as a disease of women. In fact, one of the major hospitals in Tulsa advertises osteoporosis as an area of focus at their women's health center. It's true that osteoporosis is more commonly seen in women, but why is that?


It comes down to math. Women get osteoporosis earlier and they live longer than men, in general. Let me explain.


Due to several factors, women present with osteoporosis at an earlier age--about ten years before men. For example, in my practice, women tend to present with osteoporosis and its related complications of VCF about age 65 and older. Men don't tend to present until they are in their seventies.


One reason for this discrepancy is overall bone density. Men tend to start out with high bone density than women. In the most simple terms, this is because men tend to be larger than women. While our bones are still growing, the body is actively laying down calcium and other bone minerals. This occurs until about age 25, after which the human body starts to lose bone density.

After that point, it's all downhill. The body slowly loses calcium rather than stores it. Although many factors can increase the rate at which we lose calcium, it is a part of aging. Some things that speed calcium loss are poor diet, lack of exercise, smoking, sodas and steroids.

So, although both men and women begin to lose calcium at this point, this reaches a critical level earlier in women. You can think of it like a savings account, where you have calcium instead of money--keep making the same small withdrawals and you run out over time. Since men generally have higher bone mass to start with, it takes them longer to run out.

Add to that, the fact that the life expectancy of women is typically several years longer than that of men, it's no surprise that we see more women with the disease.

Old Fractures--New Hope?

I am commonly asked the following question from referring practitioners: How old is too old when it comes to treating vertebral compression fractures (VCFs).

The answer is they are never too old if the patient is symptomatic from the fracture. Of course, many fractures heal on their own. Also, many old fractures do not cause clinical symptoms because they have healed on their own. For patients that have an older fracture that still causes pain, however, VCF fixation is highly effective.

One of my favorite examples is a patient I treated during my fellowship at the University of Oklahoma Health Sciences Center. This was an otherwise healthy lady in her thirties. She had suffered a single level VCF at from a car wreck about fifteen (15) years before. This was at T12 (one of the most common locations for these fractures).

To be sure, I was skeptical. At this point, I had experienced a lot of success from treating VCFs with vertebroplasty and kyphoplasty. Up until now, though, we had always used MRI as the gold standard for which fractures to treat. This patient's vertebral body had an abnormal shape, but no other signs of a unhealed fracture on MRI. So, her MRI was considered negative.

Her neurosurgeon, however, felt that the pain was due to the fracture. After examining her, we agreed. She had pain that was the classic 10 out of 10 and was worse with axial loading, such as standing and transferring from chairs.

We treated that patient with kyphoplasty and she was pain free afterwards--her postoperative pain level was zero. Since then, I've treated numerous patients with so-called old or healed fractures. I have found that the success rate for VCF fixation is similar to that seen in other patients--nearly 100% success.

So if you or someone you know has an old fracture and your doctor has told you there is nothing that can be done--rest assured that it can be treated. For more information, contact us at info@tulsamsk.com.

Expanded Vertebroplasty Locations

I am excited to announce that another neuroradiologist, Dr. Ning Huang has joined our staff. This will allow us to expand our on-site services and increase the depth of our subspecialty expertise. We now provide vertebral compression fracture fixation in the Tulsa metropolitan area as well as western Oklahoma.