Pathologic Fractures

  • Alexandra Carrer
  • William W. Schairer
  • Dean Chou
  • Murat Pekmezci
  • Vedat Deviren
  • Sigurd H. BervenEmail author


As new technologies emerge, the applications of minimally invasive spine surgery continue to expand. The need for minimizing the morbidity of surgical access in debilitated patients has propelled a movement toward the increased use of minimally invasive spine surgery for the treatment of pathologic spine fractures.

Vertebroplasty and kyphoplasty provide an alternative for intractable back pain in patients with pathologic fractures who do not respond to nonoperative measures and who are not medically fit for an open procedure. Anterior endoscopic procedures reduce pulmonary dysfunction and prolonged hospital stay associated with open thoracotomies but have a steep learning curve. Posterior mini-open surgery and percutaneous pedicle screws avoid the complications of anterior surgery while minimizing blood loss and the extensive muscle dissection associated with traditional open surgery. The direct lateral approach allows access to the anterior column, avoiding the approach-related complications of the anterior and posterior approaches but requiring detailed anatomic knowledge to avoid injury to the great vessels and nervous plexus.

Surgical treatment of pathologic vertebral compression fracture continues to change as new medical treatments emerge such as new hormone therapies for osteoporosis, new chemotherapy agents, and stereotactic high-dose radiotherapy for cancer. Even when open radical resections are needed to provide a cure, the principles of minimally invasive surgery of respecting soft tissues and minimizing collateral damage should be applied to reduce infection rates, decrease recovery time, improve functionality, and ultimately improve patients’ quality of life.


Pathologic fracture Compression fracture Metastatic Kyphoplasty/vertebroplasty Spinal stabilization Minimally invasive 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Alexandra Carrer
    • 1
  • William W. Schairer
    • 2
  • Dean Chou
    • 3
  • Murat Pekmezci
    • 2
  • Vedat Deviren
    • 3
  • Sigurd H. Berven
    • 4
    Email author
  1. 1.Department of Orthopaedic SurgeryLenox Hill HospitalNew YorkUSA
  2. 2.Department of Orthopaedic SurgeryUC San FranciscoSan FranciscoUSA
  3. 3.Department of Neurosurgery and Orthopaedic SurgeryUC San FranciscoSan FranciscoUSA
  4. 4.Department of Orthopaedics and NeurosurgeryUniversity of California San FranciscoSan FranciscoUSA

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