Journal List > J Korean Fract Soc > v.31(3) > 1099128

Kim, Kim, Shim, and Lim: Treatment Options of Osteoporotic Vertebral Compression Fractures

Abstract

This paper reviews previous studies on the treatment of osteoporotic vertebral compression fractures in elderly patients to determine what factors should be considered for successful treatment. In osteoporotic vertebral compression fractures, the primary treatment is conservative treatments. Other treatments include osteoporosis treatment, pain control, orthosis, and physical therapy. Recently, percutaneous catheterization or balloon plasty is performed for rapid pain recovery and early ambulation. Percutaneous catheterization or balloon posterior plasty is effective in reducing pain and improving the activity ability. Surgical treatment should be considered in cases of nonunion or osteonecrosis, dent, deformation, and spinal cord compression after conservative treatment has failed. In surgical treatment, posterior spinal fixation and vertebroplasty are more advantageous in terms of the amount of bleeding, operation time compared to the anterior approach, but the most appropriate method should be selected through the patient's condition and understanding of each surgical method.

Figures and Tables

Fig. 1

Kyphoplasty for an osteoporotic vertebral fracture. (A) Guide pin inserted through the pedicle. (B) After the guide pin is removed, balloon is infiltrated. (C) After the balloon removed, a bone filler device is inserted through cannula, and cement is injected (packed) into the void.

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Fig. 2

Preoperative simple radiography (A), preoperative magnetic resonance imaging (B), and postoperative simple radiography (C) of a 72-year-old female patient who had an osteoporotic L4 vertebral compression fracture. She underwent posterior decompression and fusion combined with vertebral body augmentation with polymethylmethacrylate to provide anterior spinal column support.

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Fig. 3

Algorithm for the management of osteoporotic vertebral fractures. Tx: therapy.

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Notes

Financial support This study was supported grant in 2018 from Wonkwang University.

Conflict of interests None.

References

1. Ministry of the Interior and Safety [Internet]. Sejong: Ministry of the Interior and Safety;2018. 06. 10. Available from: http://www.mois.go.kr/frt/sub/a05/ageStat/screen.do.
2. Kim SW, Chung YK. Longterm follow-up of osteoporotic vertebral fractures according to the morphologic analysis of fracture pattern. J Korean Soc Spine Surg. 2000; 7:611–617.
3. Schlaich C, Minne HW, Bruckner T, et al. Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporos Int. 1998; 8:261–267.
crossref
4. Leech JA, Dulberg C, Kellie S, Pattee L, Gay J. Relationship of lung function to severity of osteoporosis in women. Am Rev Respir Dis. 1990; 141:68–71.
crossref
5. Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR. Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med. 1999; 159:1215–1220.
6. Kim H, Chang BS, Lee CK. Considerations for surgical treatment of osteoporotic spinal fracture: surgical indication, approach, fixation, and graft material. J Korean Soc Spine Surg. 2016; 23:41–53.
crossref
7. An KC. Nonoperative treatment of osteoporotic vertebral compression fracture. J Korean Fract Soc. 2009; 22:214–217.
crossref
8. Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B. Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials. JAMA. 2005; 293:2257–2264.
9. Pfeifer M, Begerow B, Minne HW, Suppan K, Fahrleitner-Pammer A, Dobnig H. Effects of a long-term vitamin D and calcium supplementation on falls and parameters of muscle function in community-dwelling older individuals. Osteoporos Int. 2009; 20:315–322.
crossref
10. Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007; 370:657–666.
crossref
11. Committee for Physician's Guide of the Korean Society for Bone and Mineral Research. Physician's guide for diagnosis & treatmentof osteoporosis. Seoul: SeoHeung;2008. p. 35–88.
12. Chang JS. Osteoporotic fracture-medical treatment. J Korean Fract Soc. 2010; 23:326–340.
crossref
13. Body JJ, Gaich GA, Scheele WH, et al. A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab. 2002; 87:4528–4535.
crossref
14. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001; 344:1434–1441.
crossref
15. Kanis JA, Johnell O, Black DM, et al. Effect of raloxifene on the risk of new vertebral fracture in postmenopausal women with osteopenia or osteoporosis: a reanalysis of the multiple outcomes of raloxifene evaluation trial. Bone. 2003; 33:293–300.
crossref
16. Delmas PD. Clinical potential of RANKL inhibition for the management of postmenopausal osteoporosis and other metabolic bone diseases. J Clin Densitom. 2008; 11:325–338.
crossref
17. Lewiecki EM. Denosumab update. Curr Opin Rheumatol. 2009; 21:369–373.
crossref
18. Lieberman IH, Mazanec DJ. Medical management of osteoporosis and vertebral compression fracture [Internet]. Montclair (NJ): SpineUniverse;2003. 01. 25. Available from: www.spineuniverse.com/displayarticle.php/article2041.html.
19. Ahn DK, Lee S, Choi DJ, Park HS, Kim KS, Kim TW. The efficacy of kyphoplasty on osteoporotic vertebral compression fracture: a 1-year follow-up study. J Korean Soc Spine Surg. 2009; 16:79–88.
crossref
20. Riggs BL, Melton LJ 3rd. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone. 1995; 17:505S–511S.
crossref
21. Cyteval C, Sarrabère MP, Roux JO, et al. Acute osteoporotic vertebral collapse: open study on percutaneous injection of acrylic surgical cement in 20 patients. AJR Am J Roentgenol. 1999; 173:1685–1690.
crossref
22. Kin K, Kushida K, Yamazaki K, Okamoto S, Inoue T. Bone mineral density of the spine in normal Japanese subjects using dual-energy X-ray absorptiometry: effect of obesity and menopausal status. Calcif Tissue Int. 1991; 49:101–106.
crossref
23. Koh YD, Kim JO, Kim RG, Kim DY, Kim NK, Kim DJ. Survival analysis of conservative treatment in osteoporotic vertebral fracture. J Korean Soc Spine Surg. 2012; 19:138–144.
crossref
24. Galibert P, Déramond H. Percutaneous acrylic vertebroplasty as a treatment of vertebral angioma as well as painful and debilitating diseases. Chirurgie. 1990; 116:326–334. discussion 335.
25. Belkoff SM, Mathis JM, Fenton DC, Scribner RM, Reiley ME, Talmadge K. An ex vivo biomechanical evaluation of an inflatable bone tamp used in the treatment of compression fracture. Spine (Phila Pa 1976). 2001; 26:151–156.
crossref
26. Ledlie JT, Renfro M. Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg. 2003; 98:1 Suppl. 36–42.
crossref
27. Pourtaheri S, Luo W, Cui C, Garfin S. Vertebral augmentation is superior to nonoperative care at reducing lower back pain for symptomatic osteoporotic compression fractures: a meta-analysis. Clin Spine Surg. 2018; [epub]. DOI: 10.1097/BSD.0000000000000670.
28. Rao RD, Singrakhia MD. Painful osteoporotic vertebral fracture. Pathogenesis, evaluation, and roles of vertebroplasty and kyphoplasty in its management. J Bone Joint Surg Am. 2003; 85:2010–2022.
29. Garfin SR, Yuan HA, Reiley MA. New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine (Phila Pa 1976). 2001; 26:1511–1515.
30. Lieberman IH, Dudeney S, Reinhardt MK, Bell G. Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine (Phila Pa 1976). 2001; 26:1631–1638.
crossref
31. Han S, Jang IT. Analysis of adjacent fractures after two-level percutaneous vertebroplasty: is the intervening vertebral body prone to re-fracture? Asian Spine J. 2018; 12:524–532.
crossref
32. Nagaraja S, Awada HK, Dreher ML. Vertebroplasty increases trabecular microfractures in elderly female cadaver spines. Osteoporos Int. 2015; 26:2029–2234.
crossref
33. Zhang H, Xuan J, Chen TH, et al. Projection of the most anterior line of the spinal canal on lateral radiograph: an anatomic study for percutaneous kyphoplasty and percutaneous vertebroplasty. J Invest Surg. 2018; [epub]. DOI: 10.1080/08941939.2018.1480676.
crossref
34. Ito Y, Hasegawa Y, Toda K, Nakahara S. Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture. Spine J. 2002; 2:101–106.
crossref
35. Abdelrahman H, Siam AE, Shawky A, Ezzati A, Boehm H. Infection after vertebroplasty or kyphoplasty. A series of nine cases and review of literature. Spine J. 2013; 13:1809–1817.
crossref
36. Sudo H, Ito M, Kaneda K, et al. Anterior decompression and strut graft versus posterior decompression and pedicle screw fixation with vertebroplasty for osteoporotic thoracolumbar vertebral collapse with neurologic deficits. Spine J. 2013; 13:1726–1732.
crossref
37. Kanayama M, Ishida T, Hashimoto T, et al. Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebral collapse. J Spinal Disord Tech. 2010; 23:53–56.
crossref
38. Ito M, Kaneda K. Osteopenia: vertebrectomy and fusion. In : Herkowitz HN, Dvorak J, Bell GR, editors. The lumbar spine. 3rd ed. Philadelphia (PA): Lippincott Williams & Wilkins;2004. p. 683–689.
39. Kaneda K, Asano S, Hashimoto T, Satoh S, Fujiya M. The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis. Spine (Phila Pa 1976). 1992; 17:S295–S303.
crossref
40. Matsuyama Y, Goto M, Yoshihara H, et al. Vertebral reconstruction with biodegradable calcium phosphate cement in the treatment of osteoporotic vertebral compression fracture using instrumentation. J Spinal Disord Tech. 2004; 17:291–296.
crossref
41. Saita K, Hoshino Y, Higashi T, Yamamuro K. Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis. Spinal Cord. 2008; 46:16–20.
crossref
42. Korovessis P, Hadjipavlou A, Repantis T. Minimal invasive short posterior instrumentation plus balloon kyphoplasty with calcium phosphate for burst and severe compression lumbar fractures. Spine (Phila Pa 1976). 2008; 33:658–667.
crossref
43. Sudo H, Ito M, Abumi K, et al. One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. Eur Spine J. 2010; 19:907–915.
crossref
44. Uchida K, Nakajima H, Yayama T, et al. Vertebroplasty-augmented short-segment posterior fixation of osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine: comparisons with posterior surgery without vertebroplasty and anterior surgery. J Neurosurg Spine. 2010; 13:612–621.
crossref
45. Kashii M, Yamazaki R, Yamashita T, et al. Surgical treatment for osteoporotic vertebral collapse with neurological deficits: retrospective comparative study of three procedures: anterior surgery versus posterior spinal shorting osteotomy versus posterior spinal fusion using vertebroplasty. Eur Spine J. 2013; 22:1633–1642.
crossref
TOOLS
ORCID iDs

Yu Mi Kim
https://orcid.org/0000-0002-1041-2127

Tae Kyun Kim
https://orcid.org/0000-0001-9276-4419

Dae Moo Shim
https://orcid.org/0000-0001-6116-3485

Kyeong Hoon Lim
https://orcid.org/0000-0002-3728-2342

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