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