Compression Fractures
Compression fractures of the spine are common, especially in older patients, but luckily there are surgical and non-surgical options. Dr. Xun Li discusses the signs of compression fractures, the symptoms, possible treatment options, and more.
Featured Speaker:
He completed his neurosurgery residency at Brown University and his orthopedic spine surgery fellowship at the University of Pennsylvania. During residency, in addition to mastering the surgical treatment of common spinal disorders such as spinal stenosis and disc herniation by both open and minimally invasive approaches, he spent an additional year learning how to treat rarer neurosurgical diseases such as brain and spine tumors including metastasis. Lastly, during his fellowship, he also trained at the Shriners Hospital for Children in Philadelphia, where he learned to treat pediatric and adolescent scoliosis and other complex spinal deformities. Dr. Li’s philosophy of care is to treat every patient he meets as if they are members of his family, with compassion, respect, and dignity.
Xun Li, MD
Dr. Xun Li is a bilingual brain, spine, and nerve surgeon with expertise in spinal surgery. Dr. Li was born in Beijing, China but grew up all over the world and finally settled in the suburbs of Philadelphia in high school along with his family. Unprepared for the exorbitant cost of American higher education, he was finally able to attend Allegheny College and Temple University School of Medicine with generous scholarship support.He completed his neurosurgery residency at Brown University and his orthopedic spine surgery fellowship at the University of Pennsylvania. During residency, in addition to mastering the surgical treatment of common spinal disorders such as spinal stenosis and disc herniation by both open and minimally invasive approaches, he spent an additional year learning how to treat rarer neurosurgical diseases such as brain and spine tumors including metastasis. Lastly, during his fellowship, he also trained at the Shriners Hospital for Children in Philadelphia, where he learned to treat pediatric and adolescent scoliosis and other complex spinal deformities. Dr. Li’s philosophy of care is to treat every patient he meets as if they are members of his family, with compassion, respect, and dignity.
Transcription:
Compression Fractures
Scott Webb: Compression fractures of the spine are common, especially in older patients. But the good thing is there are surgical and nonsurgical treatment options. And joining me today to discuss the signs, symptoms and treatment options, including lumbar kyphoplasty, is Dr. Xun Li. He's a neurosurgeon and spine surgeon with Jamaica Hospital Medical Center.
This is Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm Scott Webb. So Dr. Li, thanks so much for your time today. We're going to learn about compression fractures, and I don't think I've ever had one or any. But I know I have shrunk a little bit, and we're going to kind of get to that and what that means related to compression fractures. But before we get rolling here, just tell us a little bit about yourself, what do you do, how do you do it, what's your approach to care and so on.
Dr. Xun Li: My name is Xun Li. I'm a fellowship-trained spine surgeon. I have a background in both spine oncology and also deformity surgery. So, my expertise is in the spine, surgical care of the spine.
Scott Webb: I've never had a compression fracture, but I know many folks do, and you probably treat those folks. So, let's start here by having you explain what is a compression fracture and what are some of the causes of developing a compression fracture?
Dr. Xun Li: So, compression fractures are located usually in the thoracic or lumbar spine. And the way that I think of them are sort of like stacked boxes that are crushed. Our spinal column in general looks like stacked boxes. And as we age and we develop osteoporosis, some of these boxes get deformed and get crushed under normal weight.
Scott Webb: Yeah. Got it. And I'm sure that it's a fairly common thing, fairly common injury, and you probably see a lot of these. So, are there certain groups that are more likely to suffer compression fractures? You know, how common are they?
Dr. Xun Li: They tend to affect the elderly. Usually in post-menopausal women as their bones get weaker, they suffer these compression fractures and they usually require only very minor trauma to occur. Some of my patients, they come in, they say, "Oh, I just sat down too hard and had this severe pain in my back" or some say, "Oh yeah, I woke up in the morning and twisted the wrong way, and all of a sudden I had this severe back pain that developed." So in general, in the elderly population, it's not uncommon. But it's also the reason why you see some people get shorter with time as they get older, it's mostly due to compression fractures.
Scott Webb: Yeah, I've often wondered, you know, it seems like back in the day, you know, grandma and grandpa seemed to be getting shorter and we would all sort of, you know, have a laugh, not at their expense, but it just seemed like they just kept getting smaller and smaller. So, good to understand at least a sense of how that's happening. So, what are some of the traditional ways that doctors have treated compression fractures and what are some of the issues that these different options might cause people to have to think about?
Dr. Xun Li: Traditionally, the only treatment options were bedrest and oral analgesics like Tylenol, ibuprofen and, in severe cases, maybe narcotics. But again, we try to avoid narcotics in especially the elderly because they're more prone to falls. But nowadays, more recently, we have a new procedure called kyphoplasty where it's a same-day outpatient procedure where the patient comes in the morning. They get anesthetized. Usually, they're awake. It's sort of like getting a colonoscopy. You don't need a tube to help you breathe. You're semi-awake. You're put on the interventional radiology suite table where a needle is placed into the compression fracture, and we reinforce that particular segment with cement.
So, there are two goals of this procedure. Number one is to reinforce the compression fracture. So it's as if, you know, the box that I described earlier is reinforced, so it restores some of the height. But at the same time, the cement actually helps with pain control as well. So, this is like a 45-minute to an hour procedure. Patients wake up and they usually go home the same day. And immediately post-procedurally, they feel relief from their pain.
Scott Webb: Yeah, feel relief and may feel a bit taller, which I'm sure they appreciate. And just wondering, what's the recovery time like?
Dr. Xun Li: Yeah. So, they go home the same day and they usually see me once or twice, you know, at the following month or so, just to make sure everything went fine. They usually get an x-ray at the followup visit just to make sure there was adequate height restoration. And also, down the line just because someone had a previous compression fracture, they're more prone to having another one. So, I'd like to, you know, see them on regular basis just to monitor that, to see if further fractures occur or not.
Scott Webb: Yeah, obviously. Once you've had compression fractures, you may be more prone, let's say to, you know, having them again, even if you've done the kyphoplasty, the repair. So, what have you found the results to be compared to medications and braces? Do you find that kyphoplasty is really going to be the gold standard if it isn't already? Is it permanent? Do you need to go back in later? Maybe take us through that.
Dr. Xun Li: I truly believe that kyphoplasty offers a better treatment option than the traditional way of bedrest and pain medication. Usually, the traditional teaching is that it takes anywhere from eight to 12 weeks, so two to three months of time for bones to heal. So if you just let the body heal itself, which is possible, you know, but you'll be suffering for two to three months. Whereas, you know, with this procedure, people usually get significant relief from pain and they go about their, you know, daily lives the next day.
Scott Webb: That's awesome. So virtually, you know, no recovery time, perhaps get a little taller. They get rid of the pain. I mean, seems like a no-brainer, really. Seems like kyphoplasty really, if it's not already, it should be the gold standard. So, how does someone become a candidate, right? When we think about kyphoplasty in Jamaica Hospital, what makes someone a good candidate for this?
Dr. Xun Li: Yeah. Someone who had a recent compression fracture. So more acutely, they're better candidates because, as we let the compression fracture sit, it chronicizes and the bones start to heal itself. And at that point, it's much harder to restore the height of the bone. As long as they're within, you know, maybe two to four weeks from when they first started developing symptoms, that's a good time to perform this procedure.
Scott Webb: That's awesome. Well, it's been great to learn more about this today. Any final thoughts and takeaways when you think about compression fractures, how you can help folks and the benefits of kyphoplasty?
Dr. Xun Li: Yeah, I think this is one of those procedures where it's been around for a few years, but not advertised or not discussed more often. And I think this is a great option for people who have compression fractures, and people often think, oh, just because they had a fracture, which is a big, scary word, you know, in their spine and they need "spine surgery," people tend to shy away from visiting a spine surgeon. But that's not always the case. Nowadays, we have a lot of options in terms of treating pain, discomfort, weakness in the legs, et cetera. So, this is what I call minimally invasive way to treat a very common problem and with very good outcomes.
Scott Webb: Yeah, that's awesome to hear. You know, there are some buzzwords, doctor, in medicine that we all want to hear. Minimally invasive, certainly. Sometimes if robots are involved, even better. But minimally invasive, fast recovery times, smaller scars, all that good stuff. So, really great to learn more about kyphoplasty today. Thanks so much for your time. You stay well.
Dr. Xun Li: Thank you. You too. Nice talking with you.
Scott Webb: And for more information about the Division of Neurosurgery at Jamaica Hospital or to make an appointment with one of the surgeons, please call 718-206-7001.
And if you found this podcast helpful, please be sure to share on social media and check out the rest of our library at jamaicahospital.org/podcasts. Thanks for listening to Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm Scott Webb. Stay well.
Host: All the content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast.
Compression Fractures
Scott Webb: Compression fractures of the spine are common, especially in older patients. But the good thing is there are surgical and nonsurgical treatment options. And joining me today to discuss the signs, symptoms and treatment options, including lumbar kyphoplasty, is Dr. Xun Li. He's a neurosurgeon and spine surgeon with Jamaica Hospital Medical Center.
This is Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm Scott Webb. So Dr. Li, thanks so much for your time today. We're going to learn about compression fractures, and I don't think I've ever had one or any. But I know I have shrunk a little bit, and we're going to kind of get to that and what that means related to compression fractures. But before we get rolling here, just tell us a little bit about yourself, what do you do, how do you do it, what's your approach to care and so on.
Dr. Xun Li: My name is Xun Li. I'm a fellowship-trained spine surgeon. I have a background in both spine oncology and also deformity surgery. So, my expertise is in the spine, surgical care of the spine.
Scott Webb: I've never had a compression fracture, but I know many folks do, and you probably treat those folks. So, let's start here by having you explain what is a compression fracture and what are some of the causes of developing a compression fracture?
Dr. Xun Li: So, compression fractures are located usually in the thoracic or lumbar spine. And the way that I think of them are sort of like stacked boxes that are crushed. Our spinal column in general looks like stacked boxes. And as we age and we develop osteoporosis, some of these boxes get deformed and get crushed under normal weight.
Scott Webb: Yeah. Got it. And I'm sure that it's a fairly common thing, fairly common injury, and you probably see a lot of these. So, are there certain groups that are more likely to suffer compression fractures? You know, how common are they?
Dr. Xun Li: They tend to affect the elderly. Usually in post-menopausal women as their bones get weaker, they suffer these compression fractures and they usually require only very minor trauma to occur. Some of my patients, they come in, they say, "Oh, I just sat down too hard and had this severe pain in my back" or some say, "Oh yeah, I woke up in the morning and twisted the wrong way, and all of a sudden I had this severe back pain that developed." So in general, in the elderly population, it's not uncommon. But it's also the reason why you see some people get shorter with time as they get older, it's mostly due to compression fractures.
Scott Webb: Yeah, I've often wondered, you know, it seems like back in the day, you know, grandma and grandpa seemed to be getting shorter and we would all sort of, you know, have a laugh, not at their expense, but it just seemed like they just kept getting smaller and smaller. So, good to understand at least a sense of how that's happening. So, what are some of the traditional ways that doctors have treated compression fractures and what are some of the issues that these different options might cause people to have to think about?
Dr. Xun Li: Traditionally, the only treatment options were bedrest and oral analgesics like Tylenol, ibuprofen and, in severe cases, maybe narcotics. But again, we try to avoid narcotics in especially the elderly because they're more prone to falls. But nowadays, more recently, we have a new procedure called kyphoplasty where it's a same-day outpatient procedure where the patient comes in the morning. They get anesthetized. Usually, they're awake. It's sort of like getting a colonoscopy. You don't need a tube to help you breathe. You're semi-awake. You're put on the interventional radiology suite table where a needle is placed into the compression fracture, and we reinforce that particular segment with cement.
So, there are two goals of this procedure. Number one is to reinforce the compression fracture. So it's as if, you know, the box that I described earlier is reinforced, so it restores some of the height. But at the same time, the cement actually helps with pain control as well. So, this is like a 45-minute to an hour procedure. Patients wake up and they usually go home the same day. And immediately post-procedurally, they feel relief from their pain.
Scott Webb: Yeah, feel relief and may feel a bit taller, which I'm sure they appreciate. And just wondering, what's the recovery time like?
Dr. Xun Li: Yeah. So, they go home the same day and they usually see me once or twice, you know, at the following month or so, just to make sure everything went fine. They usually get an x-ray at the followup visit just to make sure there was adequate height restoration. And also, down the line just because someone had a previous compression fracture, they're more prone to having another one. So, I'd like to, you know, see them on regular basis just to monitor that, to see if further fractures occur or not.
Scott Webb: Yeah, obviously. Once you've had compression fractures, you may be more prone, let's say to, you know, having them again, even if you've done the kyphoplasty, the repair. So, what have you found the results to be compared to medications and braces? Do you find that kyphoplasty is really going to be the gold standard if it isn't already? Is it permanent? Do you need to go back in later? Maybe take us through that.
Dr. Xun Li: I truly believe that kyphoplasty offers a better treatment option than the traditional way of bedrest and pain medication. Usually, the traditional teaching is that it takes anywhere from eight to 12 weeks, so two to three months of time for bones to heal. So if you just let the body heal itself, which is possible, you know, but you'll be suffering for two to three months. Whereas, you know, with this procedure, people usually get significant relief from pain and they go about their, you know, daily lives the next day.
Scott Webb: That's awesome. So virtually, you know, no recovery time, perhaps get a little taller. They get rid of the pain. I mean, seems like a no-brainer, really. Seems like kyphoplasty really, if it's not already, it should be the gold standard. So, how does someone become a candidate, right? When we think about kyphoplasty in Jamaica Hospital, what makes someone a good candidate for this?
Dr. Xun Li: Yeah. Someone who had a recent compression fracture. So more acutely, they're better candidates because, as we let the compression fracture sit, it chronicizes and the bones start to heal itself. And at that point, it's much harder to restore the height of the bone. As long as they're within, you know, maybe two to four weeks from when they first started developing symptoms, that's a good time to perform this procedure.
Scott Webb: That's awesome. Well, it's been great to learn more about this today. Any final thoughts and takeaways when you think about compression fractures, how you can help folks and the benefits of kyphoplasty?
Dr. Xun Li: Yeah, I think this is one of those procedures where it's been around for a few years, but not advertised or not discussed more often. And I think this is a great option for people who have compression fractures, and people often think, oh, just because they had a fracture, which is a big, scary word, you know, in their spine and they need "spine surgery," people tend to shy away from visiting a spine surgeon. But that's not always the case. Nowadays, we have a lot of options in terms of treating pain, discomfort, weakness in the legs, et cetera. So, this is what I call minimally invasive way to treat a very common problem and with very good outcomes.
Scott Webb: Yeah, that's awesome to hear. You know, there are some buzzwords, doctor, in medicine that we all want to hear. Minimally invasive, certainly. Sometimes if robots are involved, even better. But minimally invasive, fast recovery times, smaller scars, all that good stuff. So, really great to learn more about kyphoplasty today. Thanks so much for your time. You stay well.
Dr. Xun Li: Thank you. You too. Nice talking with you.
Scott Webb: And for more information about the Division of Neurosurgery at Jamaica Hospital or to make an appointment with one of the surgeons, please call 718-206-7001.
And if you found this podcast helpful, please be sure to share on social media and check out the rest of our library at jamaicahospital.org/podcasts. Thanks for listening to Jamaica Hospital Med Talk, the podcast from Jamaica Hospital Medical Center. I'm Scott Webb. Stay well.
Host: All the content of this podcast is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast.