Fig. 16.1 X-ray image showing multiple osteoporotic vertebral fractures of the thoracic and lumbar spine.
Fig. 16.2 MRI examination with evidence of bone oedema (high signal intensity on fat suppressed imaging), which provides evidence for the presence of new base and upper plate breaks of the T12, L2 and L4 vertebral bodies
Fig. 16.3 Stabilisation of the fractures using bone cement
Geriatric traumatology and the treatment of osteoporotic vertebral body fractures of the thoracic and lumbar spine are becoming increasingly important.
The cause is the status of lowered bone quality (osteoporosis). This is associated with a greatly increased susceptibility to sustain vertebral body fractures. Often, an "accident" may not even occur; vertebral fractures occur spontaneously or are the result of so-called minor (“trivial”) injuries. Patients report experiencing sudden severe pain in the spine area. In the long term, untreated insufficiency fractures of the thoracic and lumbar spine often lead to a loss of posture, hump formation, a marked decrease in body size and other secondary symptoms. If the discomfort is so pronounced that it leads to the patient becoming bedridden regardless of ongoing treatment with pain medication and a support corset/cast, surgery should be considered.
If a newly occurring vertebral fracture is detected with X-ray or MRI, the affected vertebral body can be strengthened and even restored by applying bone cement as shown in the following patient example. The cement is introduced into the affected vertebra via a small cut in the skin with a hollow needle. The method is called vertebroplasty (Fig. 16.3).
If the collapsed, deformed vertebral body is restored to its original height with the aid of an expandable balloon or stent before the cement filling procedure, this is referred to as kyphoplasty or stentoplasty.
After the administration of pain medication, both surgical procedures can be performed under local anaesthesia. A general anaesthesia is only useful if several vertebral bodies have to be treated or the patient is unable to rest on their abdomen for the duration of the procedure. Since the bone cement achieves complete stability after only 10 to 20 minutes, the treated vertebrae are able to be fully loaded immediately, i.e. the patient can stand up directly after the treatment. Longer hospital stays or extensive aftercare are generally not necessary. It is not only important to assess the exact cause of osteoporosis, but also to minimise the risk of future vertebral fractures and osteoporotic fractures in other regions of the body.
For more information on maintaining one’s health and strong bones, please refer to the recommended literature.