Vertebral Augmentation for Osteoporotic Compression Fractures
Daisuke Togawa, MD , P h D
and Isador H. Lieberman, MD , MBA , FRCS ( C )
INTRODUCTION
Osteoporosis is a systemic disease currently afflicting approx 44 million Americans;
this figure will increase as the population ages. It results in progressive bone mineral loss and concurrent changes in bony architecture that leave bone vulnerable to fracture, often after minimal or no trauma. The spine is the most common site of osteoporotic fracture, with vertebral compression fracture (VCF) occurring in 20% of people over the age of 70 yr, and up to 50% of women 80 yr and older (1,2). Overall, 700,000 people per year in the United States suffer a VCF, exceeding even the frequency of hip fractures (3).
Osteoporotic VCFs have been shown to be associated with up to a 30% age-adjusted increase in mortality (4). The cost to society of managing osteoporotic VCF patients in the United States in 1995 was $746 million (5). Possible acute complications of vertebral fracture include cord compression, urinary retention, and ileus (6). Long-term consequences include considerable pain (reported in 35% of detectable VCFs) (7) as well as pulmonary compromise (a 9% loss in predicted forced vital capacity with each vertebral fracture) (8). Other chronic sequelae include deconditioning, deformity, insomnia, and depression, resulting in substantial physical, functional, and psychosocial impairment (8,9).
Nonoperative Management of VCFs
Two-thirds of patients with acute, painful VCFs experience pain improvement regard- less of the treatment applied. Traditional, nonoperative management includes bed rest, analgesics, and bracing. This type of medical management, however, fails to restore spinal alignment, and the lack of mobility itself can result in secondary complications, includ- ing worsening osteoporosis, atelectasis, pneumonia, deep vein thrombosis, decubitus ulcer, and pulmonary embolism. An alternative approach is supervised ambulatory mobility by a physiotherapist plus hydrotherapy (10). In one-third of patients, severe pain, limited mobility, and poor quality of life persist despite appropriate nonoperative management.
Whether the pain has resolved or not, no patient after a VCF spontaneously achieves a realigned spine, corrected sagittal contour, or restoration of vertebral height.
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From: Arthroscopic and Endoscopic Spinal Surgery: Text and Atlas: Second Edition Edited by: P. Kambin © Humana Press Inc., Totowa, NJ