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Z Orthop Unfall 2019; 157(06): 654-667
DOI: 10.1055/a-0826-5180
Review/Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Surgical and Non-surgical Treatment of Vertebral Fractures in Elderly

Article in several languages: English | deutsch
Marc Chmielnicki
1   Klinik für Unfall- und Wiederherstellungschirurgie, Klinikverbund Südwest, Kliniken Sindelfingen
,
Axel Prokop
1   Klinik für Unfall- und Wiederherstellungschirurgie, Klinikverbund Südwest, Kliniken Sindelfingen
,
Frank Kandziora
2   Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main
,
Andreas Pingel
2   Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, Berufsgenossenschaftliche Unfallklinik, Frankfurt am Main
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Publication History

Publication Date:
23 May 2019 (online)

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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