Abstract
Demographic development in Germany has led to an aging of the population. Particularly
for these patients, osteoporosis-induced vertebral fractures represent a significant
decrease in quality of life and level of activity. According to current guidelines,
the initial treatment of stable osteoporotic vertebral fractures is conservative management
with analgesic, anti-osteoporotic, physical therapy, and orthotic measures as first
line options. Personal experience, however, suggests that patients benefit from timely
surgical treatment through rapid improvement of pain symptoms and thus, more rapid
mobilization. The poor bone quality of elderly patients presents the treating spine
surgeon a challenge in achieving stable spinal fusion with or without support, for
example, through augmentation. Minimally invasive procedures have increasingly established
themselves for such purposes in recent years. With over 1000 fracture treatments in
the last 3.5 years, we have developed a differentiated treatment concept depending
on patient age and fracture morphology, which we would like to introduce. Unstable
fractures with posterior edge involvement are stabilized from posterior with a percutaneous
fixator. Patients over 60 years were treated percutaneously with a polyaxial screw
system. Increased stability was achieved by PMMA cement augmentation of the fenestrated
screws. In elderly patients with Magerl A3 fractures without neurologic deficit, the
index vertebra is supplementally treated with kyphoplasty (hybrid treatment). In acute,
stable osteoporotic vertebral fractures with severe pain despite analgesics, we perform
kyphoplasty, which is possible even in high thoracic fractures to T3 with smaller
balloons and thinner trocars. Vertebroplasty is another option in the lumbar and lower
thoracic spine. Because of invasiveness, extended posterior–anterior correction procedures
are generally avoided in this population, which has frequent multiple comorbidities.
Key words
osteoporosis - spine surgery - vertebral fracture - cement augmentation - percutaneous
stabilization
