Osteoporotic spinal fractures

Management of osteoporotic spinal fractures.

A fragility fracture of the spine.

Demographics – affects up to

• 25% people over 70 years
• 50% people over 80 years.

Risk factors

• history of 2 vertebral compression fractures (VCFs) is the strongest predictor of future vertebral fractures in postmenopausal women

Definition-WHO defines osteoporosis as T score below -2.5

Prognosis-with VCFs mortality increases significantly (even greater than hip fractures at 2 years)

• Symptoms
  • pain
    • 25% of VCR are painful enough that patients seek medical attention
    • pain usually localized to area of fracture, but may wrap around rib cage
• Physical exam
  • Focal tenderness – pain with deep palpation of spinous process
  • Local deformity – multiple compression fractures can lead to local kyphosis
  • Spinal cord injury and nerve root deficits
• Radiographs
• CT scan
• MRI
• Laboratory

Diffrentials-Metastatic cancer to the spine

Treatment

• Nonoperative-observation, bracing, and medical management
• Operative
  • Vertebroplasty
  • Kyphoplasty
  • Surgical decompression and stabilization

Technique

• Performed under flouroscopic guidance
• Percutaneous transpedicular approach used for cannula
• kyphoplasty
  • cavity created with expansion device (e.g., balloon) prior to PMMA injection
  • may be possible to obtain partial reduction of fracture with balloon expansion