2 Clinical need and practice

2.1 Vertebral fracture refers to a break in any of the bones (vertebrae) of the spinal column. Vertebral compression fractures usually occur when the front of the vertebral body collapses, and may be caused by trauma, cancer or osteoporosis. Osteoporotic vertebral compression fractures can cause the spine to curve and lose height, and can result in pain, difficulties in breathing, gastrointestinal problems, sleep disturbances and difficulties in performing activities of daily living. High doses of analgesics used to treat such pain can have significant adverse effects. The symptoms and treatment of osteoporotic vertebral compression fractures can worsen quality of life and cause loss of self-esteem.

2.2 The prevalence of vertebral fractures increases with age and is more common in women. It is estimated that approximately 2.5 million people in England and Wales have osteoporosis. The prevalence of osteoporotic vertebral compression fractures is difficult to estimate because not all fractures come to the attention of clinicians and they are not always recognised on X-rays. Clinically evident osteoporotic vertebral compression fractures are associated with an increase in mortality.

2.3 Treating vertebral compression fractures aims to restore mobility, reduce pain and minimise the incidence of new fractures. Non‑invasive treatment (such as pain medication, bed rest, and back braces) focuses on alleviating symptoms and supporting the spine. Percutaneous vertebroplasty (NICE interventional procedure guidance 12) and Balloon kyphoplasty for vertebral compression fractures (NICE interventional procedure guidance 166) support the use of percutaneous vertebroplasty and percutaneous balloon kyphoplasty without stenting (hereafter vertebroplasty and kyphoplasty respectively) as options for treating vertebral fractures. These guidance documents note that patients should receive these procedures only after discussion with a specialist multidisciplinary team, and in an appropriately resourced facility that has access to a spinal surgery service. For vertebroplasty, the guidance also states that the procedure should be limited to people whose pain does not respond to more conservative treatment.

  • National Institute for Health and Care Excellence (NICE)