Osteoporotic Thoracolumbar Fractures—How Are They Different?—Classification and Treatment Algorithm

Abstract

Osteoporotic vertebral fractures constitute at least 50% of the osteoporotic fractures that happen worldwide. Occurrence of osteoporotic fractures make the elderly patient susceptible for further fractures and increases the morbidity due to kyphosis and pain; the mortality risk is also increased in these patients. Most fractures occur in the thoracic and thoracolumbar region and are often stable. Different descriptive and prognostic classification systems have been described, but none are universally accepted. Radiographs, computed tomography, and magnetic resonance imaging are useful in imaging the fracture and evaluating the bone density. In acute stages, the fractures are well treated with conservative measures including short bed rest, analgesics, bracing, and exercises. Although most fractures heal well, up to 30% of fractures can develop painful nonunion, progressive kyphosis, and neurological deficit. For patients who develop severe pain not responding to nonoperative measures and painful nonunion, percutaneous cement augmentation procedures including vertebroplasty or kyphoplasty have been suggested. For fractures with severe collapse and that lead to neurological deficit and increasing kyphosis, instrumented stabilization is advised. Prevention and management of osteoporosis is the key element in the management of osteoporotic fractures in the elderly. Guidelines for essential adequate dietary and supplemental calcium and vitamin D, and antiosteoporotic medications have been described.

Risk factors of adjacent segmental fractures when percutaneous vertebroplasty is performed for the treatment of osteoporotic thoracolumbar fractures

“…advised for treating OTFs in clinical routine practice, and we are unable to determine whether PV causes new symptomatic vertebral fractures and/or serious adverse events as well as an increased risk of PV in acute OTFs [9][10][11][12] . There are no severe complications due to treatment, and although PMMA leakage frequently occurs, it is always asymptomatic [13][14][15] . We observed that the radiographic outcomes of PV appeared to provide better vertebral height restoration but worse thoracolumbar kyphosis alignment.…”

Posterior Stabilization Without Neural Decompression in Osteoporotic Thoracolumbar Fractures With Dynamic Cord Compression Causing Incomplete Neurological Deficits

“…Osteoporosis is a skeletal disease with the characteristic feature of low bone mass leading to a micro architectural deterioration of bone. 12 This increases the risk of fracture even with a trivial injury. The clinical and radiologic appearances of fractures in the osteoporotic spine are different from those of a healthy spine.…”

Efficacy of percutaneous short segment fixation on the treatment of Magerl A3 thoracolumbar fractures: a retrospective study

“…The thoracolumbar (TL) region (T11-L3) is the most common area of spinal fractures due to its biomechanical characteristics; TL fractures account for 60-70% of spinal fractures (1,2). As the population ages, an increasing number of TL fractures accompanied with low bone mineral density (BMD) will occur, however, its treatment is controversial (3). Conservative therapy with extended periods of bed rest leads to bone loss, while open long segment pedicle screw xation causes intra-operative trauma to the para-spinal muscle, extensive blood loss and signi cant postoperative pain with loss of motion segments (4,5).…”