Management of osteoporosis in patients undergoing spine surgery is challenging. Still, with appropriate patient selection, medical optimization, and surgical techniques, these patients can experience pain relief, deformity correction, and improved function [130]. Surgical consultation can assist in prescribing and supervising immobilization devices. When the etiology of the VCF is questionable and not amenable to percutaneous biopsy, an open biopsy may be necessary. Vertebral Compression Fractures Radiation Oncology Consultation There is no role for RT in a patient without a cancer diagnosis and a nonpathologic VCF. If cancer is thought to be the cause of a VCF, a biopsy is needed to confirm a cancer diagnosis. RT is reserved for metastatic spinal disease and typically for those spinal metastases causing pain, neurologic compromise, or those asymptomatic lesions with radiologic features suggesting a risk of neurologic compromise or VCF. Systemic Radionuclide Therapy This procedure is not useful for benign osteoporosis-related compressions fractures. Medical Management Only Medical management is complementary to other therapies and should be offered in all clinical scenarios. Conservative management includes medical management with or without methods of immobility [36,107,108]. If there is failure of medical management with worsening of symptoms to medications or in the setting of spinal deformity or pulmonary dysfunction, other management alternatives should be considered. Patients complaining of significant pain after undergoing a VA must be re-evaluated with radiographs, CT, and MRI scans because the increased pain maybe due to progression of fracture at the same level or development of adjacent level fracture. Percutaneous Vertebral Augmentation A recent meta-analysis from 2017 comprising 1,328 patients found no increased risk for adjacent or remote level vertebral body fracture following augmentation using VP or BK compared with nonsurgical management.
Management of Vertebral Compression Fractures PCAs. Management of osteoporosis in patients undergoing spine surgery is challenging. Still, with appropriate patient selection, medical optimization, and surgical techniques, these patients can experience pain relief, deformity correction, and improved function [130]. Surgical consultation can assist in prescribing and supervising immobilization devices. When the etiology of the VCF is questionable and not amenable to percutaneous biopsy, an open biopsy may be necessary. Vertebral Compression Fractures Radiation Oncology Consultation There is no role for RT in a patient without a cancer diagnosis and a nonpathologic VCF. If cancer is thought to be the cause of a VCF, a biopsy is needed to confirm a cancer diagnosis. RT is reserved for metastatic spinal disease and typically for those spinal metastases causing pain, neurologic compromise, or those asymptomatic lesions with radiologic features suggesting a risk of neurologic compromise or VCF. Systemic Radionuclide Therapy This procedure is not useful for benign osteoporosis-related compressions fractures. Medical Management Only Medical management is complementary to other therapies and should be offered in all clinical scenarios. Conservative management includes medical management with or without methods of immobility [36,107,108]. If there is failure of medical management with worsening of symptoms to medications or in the setting of spinal deformity or pulmonary dysfunction, other management alternatives should be considered. Patients complaining of significant pain after undergoing a VA must be re-evaluated with radiographs, CT, and MRI scans because the increased pain maybe due to progression of fracture at the same level or development of adjacent level fracture. Percutaneous Vertebral Augmentation A recent meta-analysis from 2017 comprising 1,328 patients found no increased risk for adjacent or remote level vertebral body fracture following augmentation using VP or BK compared with nonsurgical management.