Osteoporotic fractures of the spine. Diagnostics & Therapy
Patients with an osteoporotic fracture of the spine often suffer from back pain, reduced mobility and limitations in daily activities. The nature of the occurring disorders depends on kind and severity of the fracture. While simple cases can be treated conservatively, eg by immobilization with a corset or muscle training, complex fractures of the vertebrae must be supplied by surgery. For this, modern surgical procedures are available today, such as kyphoplasty or vertebroplasty. The collapsed vertebrae are raised through the use of bone cement. In this way, the stability of the spine can be restored.
Diagnostics & treatment of osteoporotic fractures of the spine.
Diagnostics. How osteoporotic fractures are identified
X-ray for osteoporotic fractures of the spine.
The diagnostic procedure always commences by taking an X-ray of the thoracic and lumbar spine at two levels. These images will normally reveal a wedge-shaped or biconcave, collapsed vertebra or even, possibly, several collapsed vertebrae. X-ray examination alone does not permit any conclusions to be made, however, on which vertebra(e) is (are) newly damaged and which potentially are healed following a previous osteoporotic fracture.
Bone density measurement.
If an osteoporotic fracture of the vertebrae is ever suffered, now is the time to perform bone density measurements. The bone density in various parts of the skeleton is analysed and a prediction can be made in terms of the risk of further fractures. Two methods, above all, are commonly applied for measuring bone density:
Conservative treatment. Therapy without surgery
Most symptomatic, osteoporotic fractures of the vertebrae can be successfully treated with conservative measures. An adequate pain indication as well as pain-adjusted physiotherapy follow-up are the cornerstones of conservative therapy. Orthopaedic aids such as corsets, which help to keep the spine upright and stabilised, should be used for as short a time as possible. Such orthotic procedures can be adapted to the anatomical conditions and the patient. Targeted spinal exercises strengthen the back muscles, improve the pain situation and lower the risk of further vertebral fractures.
Surgical treatment of osteoporotic vertebral fractures.
Treatment of vertebral fractures by surgery.
Surgery is unavoidable in patients who are unresponsive to conservative therapy or in whom further sintering of the vertebral bodies is a risk. The minimal invasive surgical techniques developed to this aim, i.e.
During both procedures, known as percutaneous cement augmentation, a radiopaque, rapid-hardening polymethyl methacrylate cement is injected with a cannula into the vertebral body. The aim of both techniques, which can be performed on one or more vertebrae, is to realign the vertebral body and correct the kyphotic deformity.
This short surgical procedure is usually performed under general anaesthetic, whereby the patient is placed on his stomach to slightly overextend the spine. This immediately straightens the compressed vertebra and the highly viscous cement can be injected directly (vertebroplasty).
If positioning alone does not achieve adequate alignment of the vertebra, kyphoplasty will be undertaken. Thereby, a balloon is inserted into the vertebral body via the so-called pedicle of the vertebra and filled with fluid until it practically restores the height of the vertebral body. Following removal of the balloon, the remaining cavity is filled with bone cement. A possible complication with both procedures is the flow of cement into the blood vessels which run through the vertebral body, and into the vertebral canal. On account of such complications, these procedures should be performed only by physicians who are highly experienced in carrying out surgical interventions on the spine and also have appropriate experience of managing complications. To avoid complications, such procedures are carried out with the use of X-ray amplifiers so that escaped cement can be detected immediately.
Surgical treatment for complex osteoporotic fractures of the thoracic and lumbar spine
In some cases, the disintegration of one or more vertebral bodies related to an osteoporotic degeneration process results in a complete loss of bone structure, thus causing the load-bearing anterior column of the spine, which copes with at least 80% of the strain on the body, to fail. In such cases it is possible to carry out more complex surgical procedures in order to restore the strength of the spine and thus enable patients to resume their everyday activities. Such complex procedures involve the placement of screws in the healthy vertebrae above and below the fracture from behind, which are anchored in the vertebral bodies by inserting bone cement through perforations in the screws. Rods are then attached to either side of the screws in order to straighten and stabilise the spine. The second step is to remove the collapsed and mostly disintegrated vertebral body and replace it with a vertebral body replacement cage made of titanium. This second step can today be carried out endoscopically, via four small incisions.
Osteoporotic spine fractures
Fractures to the vertebrae are the most common fractures caused by osteoporosis.
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