Osteoporotic Vertebral Compression Fractures and Vertebral Augmentation

Abstract

Vertebral fractures account for $27% of all osteoporotic fractures in both men and women. The economic burden is substantial and growing: osteoporosis is expected to affect 14 million people by the year 2020. There is substantial morbidity associated with osteoporotic vertebral compression fractures (VCFs) including decreased quality of life, reduced pulmonary function, and increased mortality. Relatively recent additions to the treatment armamentarium include vertebral augmentation using vertebroplasty and kyphoplasty. Numerous retrospective and case studies demonstrate short-term efficacy and low complication rates of vertebroplasty and kyphoplasty in the treatment of osteoporotic VCFs, but controlled trials are needed for validation. The pathophysiology, risk factors, consequences, characteristics, and imaging of osteoporotic VCFs are presented in detail along with a discussion of treatment options and patient selection. Vertebral augmentation is comprehensively reviewed, including the technical aspects of the procedures, contraindications, complications, and clinical outcomes.

Determinants of mortality risk following osteoporotic fractures

“…Cardiovascular, renal, pulmonary diseases and reduced cognitive function have been reported in several studies of hip fracture mortality to play a role in postfracture mortality either through delaying time to surgery or increasing postoperative complications which both increase mortality risk [47,48]. Individuals with vertebral fractures, and particularly those with multiple vertebral compression fractures may develop pulmonary diseases because of progressive kyphosis, which leads to thoracic cavity reduction and decreased pulmonary function [49]. The role of co-morbidities in mortality associated with nonhip nonvertebral fracture is less clear.…”

Low Volume Vertebral Augmentation with Cortoss® Cement for Treatment of High Degree Vertebral Compression Fractures and Vertebra Plana

“…In turn, the thicker pedicle cortex, especially medially and superiorly, provides vertical and medial support to the posterior edge and wall of the osteoporotic vertebra where the pedicles are part of the middle column of the vertebra [10]. The vertebral body forming the anterior column is almost all cancellous bone and is in the center of the normal vertical load of the spinal column.…”

“…Since the pedicle makes up approximately 30 to 50% of the posterior vertebral wall vertical height, this posterior support, combined with the cancellous anterior vertebral body, explains the classic progressive anterior wedge collapse of the osteoporotic vertebra [9]. In its final stage, the vertebrae take on a vertebra plana "pancake" shape but still retains relative preservation of the pedicles [10]. This extreme collapse of the anterior vertebral body, which has no lateral support, tends to force the collapse more towards the center.…”

Semiautomatic Classification of Benign Versus Malignant Vertebral Compression Fractures Using Texture and Gray-Level Features in Magnetic Resonance Images

“…Such bone failure may be related to osteoporosis or bone metastasis [1]. Osteoporotic VCFs are an important risk factor for additional future osteoporotic fractures and are also linked to increased mortality [2]. VCFs secondary to bone metastases may represent the onset of symptoms of a patient with neoplasia or may represent a complication in patients already diagnosed with this systemic disease.…”