Surgical Considerations in Osteoporotic Dorso-Lumbar Spine Fractures.

Abstract

Background: Osteoporotic vertebral fractures are exponentially impacting health-care systems globally with the rapid increase in geriatric population. These fractures are seen most commonly in the dorso-lumbar spine. Lack of timely diagnosis and adequate treatment contributes significantly to morbidity and mortality. It has become vital to thoroughly evaluate these patients clinically, investigate them, optimise them, plan conservative and / or surgical treatment and provide comprehensive pre, peri and post-operative counselling and support.

Content: Historically, geriatric patients with multiple comorbidities with vertebral fractures were considered poor candidates for surgical treatment due to high anaesthetic and surgical risk. Those who were offered surgery were not adequately optimised pre-operatively and the fractures were under-stabilised surgically. Better understanding of the biomechanics of an osteoporotic vertebral column with dorso-lumbar fractures, combined with advances in anaesthetic and surgical techniques, implants and technologies facilitate successful surgeries on high-risk geriatric patients significantly reducing morbidity and improving quality of life. This article discusses the pathophysiology of dorso-lumbar osteoporotic vertebral fractures, their clinical presentation, investigative work-up, pre-operative optimization, indications for surgical intervention, various surgical modalities, techniques and technologies for optimal surgical outcomes, post-operative care and follow-up of patients.

Implications: In this article, the authors aim to provide an overview of the various pre, peri and postoperative considerations while dealing with patients of osteoporotic dorso-lumbar vertebral fractures. This review provides a comprehensive set of guidelines for the medical optimization and surgical management of these patients with an overview of current techniques, strategies and technologies designed to address the challenges associated with spine surgery in geriatric comorbid osteoporotic patients.

Sources: Content for this article has been sourced from routinely cited articles available via PubMed, National Institute of Health, census reports from United Nations, from previous articles by the authors and from the protocols established by the authors in their clinical practice based on experience and detailed case reviews.