Abstract
For the spine surgeon the problems of the osteoporotic spine can be a painful simple compression fracture, the persisting instability after a fracture, the silent loss of posture due to progressive collapse of multiple vertebrae, and neurological complications related to an osteoporotic fracture. The use of polymethylmethacrylate (PMMA) for the reinforcement of osteoporotic vertebral bodies has turned out to be extremely efficient. Although the natural course of pain due to vertebral fractures decreases within the first weeks in the majority of patients, there remains a number of them with persistent pain and/or ongoing vertebral collapse. With percutaneous cement injection one can achieve fast and lasting pain reduction in 80% to 93% of patients. With multilevel injections it is possible to address the severe osteoporotic spine as a whole where we can halt the ongoing collapse and preserve posture efficiently. Rectification of lordosis can be achieved in fresh fractures with the kyphoplasty technique and, even more efficiently, with the lordoplasty procedure. Kyphosis correction ranges from 8.5° to 14°, and restoration of vertebral body (VB) height goes up to 90%. When surgical stabilization is required, the combination of PMMA reinforcement and fixation with screws appears the only alternative in order to anchor the implants in the severely osteoporotic bone.
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References
Melton LJ 3rd, Kan SH, Frye MA, et al (1989) Epidemiology of vertebral fractures in women. Am J Epidemiol 129:1000–1011
Silverman SL (1992) The clinical consequences of vertebral compression fracture. Bone 13:S27–31
Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ 3rd (1992) Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985–1989. J Bone Miner Res 7:221–227
Riggs BL, Melton LJ 3rd (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:505S–511S
EPOS (2002) Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 17:716–724
Kanis JA, Pitt FA (1992) Epidemiology of osteoporosis. Bone 13:S7–15
Lee YL, Yip KM (1996) The osteoporotic spine. Clin Orthop 91–97
Ryan PJ, Blake G, Herd R, Fogelman I (1994) A clinical profile of back pain and disability in patients with spinal osteoporosis. Bone 15:27–30
Cook DJ, Guyatt GH, Adachi JD, et al (1993) Quality of life issues in women with vertebral fractures due to osteoporosis. Arthritis Rheum 36:750–756
Kado DM, Browner WS, Palermo L, et al (1999) Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 159:1215–1220
Gold DT (1996) The clinical impact of vertebral fractures: quality of life in women with osteoporosis. Bone 18:185S–189S
Schlaich C, Minne HW, Bruckner T, et al (1998) Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int 8:261–267
Center JR, Nguyen TV, Schneider D, et al (1999) Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet 353:878–882
Delmas PD (2002) Treatment of postmenopausal osteoporosis. Lancet 359:2018–2026
Lindsay R (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323
Ettinger B, Pressman A, Schein J (1998) Clinic visits and hospital admissions for care of acid-related upper gastrointestinal disorders in women using alendronate for osteoporosis. Am J Manag Care 4:1377–1382
Watts NB, Harris ST, Genant HK Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty. Osteoporos Int 12:429–437
Einhorn TA (2000) Vertebroplasty: an opportunity to do something really good for patients. Spine 25:1051–1052
Barr JD, Barr MS, Lemley TJ, McCann RM (2000) Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25:923–928
Heini PF, Walchli B, Berlemann U (2000) Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J 9:445–450
Heini P, Orler, R (2004) Vertebroplasty in extreme osteoporosis—experience with multilevel injection. Orthopade (in press)
Perez-Higueras A, Alvarez L, Rossi RE, et al (2002) Percutaneous vertebroplasty: long-term clinical and radiological outcome. Neuroradiology 44:950–954
Hodler J, Peck D, Gilula LA (2003) Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors. Radiology 227:662–668
Maynard AS, Jensen ME, Schweickert PA, et al (2000) Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures. AJNR Am J Neuroradiol 21:1807–1812
Kaufmann TJ, Jensen ME, Schweickert PA, et al (2001) Age of fracture and clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol 22:1860–1863
Brown DB, Gilula LA, Sehgal M, Shimony JS (2004) Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. AJR Am J Roentgenol 182:319–322
McKiernan F, Jensen R, Faciszewski T (2003) The dynamic mobility of vertebral compression fractures. J Bone Miner Res 18:24–29
Jang JS, Kim DY, Lee SH (2003) Efficacy of percutaneous vertebroplasty in the treatment of intravertebral pseudarthrosis associated with noninfected avascular necrosis of the vertebral body. Spine 28:1588–1592
Heini PF, Orler R (2004) Vertebroplasty for severe osteoporosis. Technique and experience with multi-segment injections. Orthopade 33:22–30
Heggeness MH (1993) Spine fracture with neurological deficit in osteoporosis. Osteoporos Int 3:215–221
Heaney RP (1992) The natural history of vertebral osteoporosis. Is low bone mass an epiphenomenon? Bone 13:S23–26
Korovessis P, Maraziotis T, Piperos G, Spyropoulos P (1994) Spontaneous burst fracture of the thoracolumbar spine in osteoporosis associated with neurological impairment: a report of seven cases and review of the literature. Eur Spine J 3:286–288
Nguyen HV, Ludwig S, Gelb D (2003) Osteoporotic vertebral burst fractures with neurologic compromise. J Spinal Disord Tech 16:10–19
Kim KT, Suk KS, Kim JM, Lee SH (2003) Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop 27:65–69
Natelson SE (1986) The injudicious laminectomy. Spine 11:966–969
Heini PF (2003) Vertebroplasty: the value of prophylactic augmentation. In: Szpalski M, Gunzburg R (eds) Vertebral osteoporotic compression fractures, pp 211–221
Wong W, Riley MA, Garfin S (2002) Vertebroplasty/kyphoplasty. J Womens Imaging 2:117–124
Garfin SR, Yuan HA, Reiley MA (2001) New technologies in the spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26:1511–1515
Phillips FM, Todd Wetzel F, Lieberman I, Campbell-Hupp M (2002) An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty. Spine 27:2173–2178; discussion 2178–2179
Heini PF, Orler R (2004) Kyphoplasty for treatment of osteoporotic vertebral fractures. Eur Spine J 3:184–192
Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 26:1631–1638
Bai B, Kummer FJ, Spivak J (2001) Augmentation of anterior vertebral body screw fixation by an injectable, biodegradable calcium phosphate bone substitute. Spine 26:2679–2683
Jang JS, Lee SH, Rhee CH (2002) Polymethylmethacrylate-augmented screw fixation for stabilization in metastatic spinal tumors. Technical note. J Neurosurg 96:131–134
Lotz JC, Hu SS, Chiu DF, et al (1997) Carbonated apatite cement augmentation of pedicle screw fixation in the lumbar spine. Spine 22:2716–2723
Wittenberg RH, Lee KS, Shea M, et al (1993) Effect of screw diameter, insertion technique, and bone cement augmentation of pedicular screw fixation strength. Clin Orthop 278–287
Moore DC, Maitra RS, Farjo LA, et al (1997) Restoration of pedicle screw fixation with an in situ setting calcium phosphate cement. Spine 22:1696–1705
Yerby SA, Toh E, McLain RF (1998) Revision of failed pedicle screws using hydroxyapatite cement. A biomechanical analysis. Spine 23:1657–1661
Wuisman PI, Van Dijk M, Staal H, Van Royen BJ (2000) Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique. Eur Spine J 9:528–533
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Heini, P.F. The current treatment—a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon’s perspective. Osteoporos Int 16 (Suppl 2), S85–S92 (2005). https://doi.org/10.1007/s00198-004-1723-1
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DOI: https://doi.org/10.1007/s00198-004-1723-1