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.
- 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)
- 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
- CT scan
Diffrentials-Metastatic cancer to the spine
- Nonoperative-observation, bracing, and medical management
- Surgical decompression and stabilization
- Performed under flouroscopic guidance
- Percutaneous transpedicular approach used for cannula
- cavity created with expansion device (e.g., balloon) prior to PMMA injection
- may be possible to obtain partial reduction of fracture with balloon expansion