The current treatment—a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon’s perspective

For the spine surgeon the problems of the osteoporotic spine can be a painful simple compression fracture, the persisting instability after a fracture, the silent loss of posture due to progressive collapse of multiple vertebrae, and neurological complications related to an osteoporotic fracture. The use of polymethylmethacrylate (PMMA) for the reinforcement of osteoporotic vertebral bodies has turned out to be extremely efficient. Although the natural course of pain due to vertebral fractures decreases within the first weeks in the majority of patients, there remains a number of them with persistent pain and/or ongoing vertebral collapse. With percutaneous cement injection one can achieve fast and lasting pain reduction in 80% to 93% of patients. With multilevel injections it is possible to address the severe osteoporotic spine as a whole where we can halt the ongoing collapse and preserve posture efficiently. Rectification of lordosis can be achieved in fresh fractures with the kyphoplasty technique and, even more efficiently, with the lordoplasty procedure. Kyphosis correction ranges from 8.5° to 14°, and restoration of vertebral body (VB) height goes up to 90%. When surgical stabilization is required, the combination of PMMA reinforcement and fixation with screws appears the only alternative in order to anchor the implants in the severely osteoporotic bone.