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Surgical management is employed for fractures caused by [[osteoporosis]]. [[Vertebroplasty]] and [[kyphoplasty]] are used to treat patients with vertebral compression fractures. For fractures of the hip, the surgical method used is called open reduction and internal fixation, or ORIF. | Surgical management is employed for fractures caused by [[osteoporosis]]. [[Vertebroplasty]] and [[kyphoplasty]] are used to treat patients with vertebral compression fractures. For fractures of the hip, the surgical method used is called open reduction and internal fixation, or ORIF. | ||
==Surgery== | ==Osteoporosis surgery== | ||
: Surgery is not the first-line treatment option for patients with osteoporosis. Osteoporosis is usually reserved for patients with either vertebral or hip fracture in patients, refractory to medical therapy. Surgery options for osteoporosis are very limited. | |||
=== Vertebroplasty === | |||
The procedure was first performed in 1984 by Galibert and Deramond, French neurosurgeons, in order to treat aggressive hemangioma in C2 vertebra. It had very satisfying outcome. The success of this procedure in a favorable way was lead to extend its usage to other destructive bone diseases, such as multiple myeloma, metastatic bone tumors, and also after a while in 1989, its usage for treatment of osteoporotic vertebral fractures was proven.<ref name="pmid2757346">{{cite journal |vauthors=Lapras C, Mottolese C, Deruty R, Lapras C, Remond J, Duquesnel J |title=[Percutaneous injection of methyl-metacrylate in osteoporosis and severe vertebral osteolysis (Galibert's technic)] |language=French |journal=Ann Chir |volume=43 |issue=5 |pages=371–6 |year=1989 |pmid=2757346 |doi= |url=}}</ref> | |||
In any patients that are refractory to long term medical therapy and encountering vertebral compression fracture, vertebroplasty would be a good option. Vertebroplasty is a minimally invasive surgery that is an image-guided by fluoroscopy assistance. In this method some bone cement (mostly polymethylmethacrylate (PMMA)) is injected in the body of vertebra that been fractured. This procedure may lead to improve stability of fractured vertebra, take it back to the normal shape. PMMA injection is done under precise fluoroscopic observation to prevent any leakage of cement into spinal canal. The most important advantages of the vertebroplasty procedure are minimal invasion rather than other open surgical methods, and rapid symptomatic relief compare to other medical treatments.<ref name="pmid28690739">{{cite journal |vauthors=Hemama M, El Fatemi N, Gana R |title=Percutaneous vertebroplasty in Moroccan patients with vertebral compression fractures |journal=Pan Afr Med J |volume=26 |issue= |pages=225 |year=2017 |pmid=28690739 |pmc=5491720 |doi=10.11604/pamj.2017.26.225.9872 |url=}}</ref> | |||
Vertebroplasty may cause rapid response in patients with osteoporosis. The patients may experience immediate pain and discomfort relief, along with gradual correction of stooped spine (kyphosis) that is occurred because of compression fracture in anterior aspect of vertebrae. The main risk for the procedure is that sometimes the cement injection may compromise the foraminal spaces, leading to radicaular pains.<ref name="pmid27072339">{{cite journal |vauthors=El-Fiki M |title=Vertebroplasty, Kyphoplasty, Lordoplasty, Expandable Devices, and Current Treatment of Painful Osteoporotic Vertebral Fractures |journal=World Neurosurg |volume=91 |issue= |pages=628–32 |year=2016 |pmid=27072339 |doi=10.1016/j.wneu.2016.04.016 |url=}}</ref> | |||
The mechanism of lowering pain in osteoporotic patients following vertebroplasty is not clear completely. Some of the proposed theories are include correcting micro-fractures, along with vascular, chemical, and also thermal factors. It is assumed that either temperature properties of injected cement destroys pain receptors, or compression effect of the cement crushed the nerve endings in situ.<ref name="pmid9536480">{{cite journal |vauthors=Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet P, Duquesnoy B, Deramond H |title=Percutaneous vertebroplasty: state of the art |journal=Radiographics |volume=18 |issue=2 |pages=311–20; discussion 320–3 |year=1998 |pmid=9536480 |doi=10.1148/radiographics.18.2.9536480 |url=}}</ref> | |||
Whereas, in 2009, Kallmes have found that rapid pain relief and symptomatic cure in osteoporotic patients with vertebral compression fracture are not significantly different from control group.<ref name="pmid19657122">{{cite journal |vauthors=Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG |title=A randomized trial of vertebroplasty for osteoporotic spinal fractures |journal=N. Engl. J. Med. |volume=361 |issue=6 |pages=569–79 |year=2009 |pmid=19657122 |pmc=2930487 |doi=10.1056/NEJMoa0900563 |url=}}</ref> | |||
==== Indications ==== | |||
Indication for surgery for osteoporosis include osteoporotic patients refractory to medical therapy encountering vertebral fracture. | |||
==== Contraindications ==== | |||
* Absolute contraindications for surgery for osteoporosis include asymptomatic vertebral fractures and patients with reasonable response to medical therapy, as well as severe coagulopathies or any ongoing local/systemic infection. However, any allergy to the cement or any other materials that may used during the operation are included, too.<ref name="pmid215001312">{{cite journal |vauthors=Hargunani R, Le Corroller T, Khashoggi K, Murphy KJ, Munk PL |title=Percutaneous vertebral augmentation: the status of vertebroplasty and current controversies |journal=Semin Musculoskelet Radiol |volume=15 |issue=2 |pages=117–24 |year=2011 |pmid=21500131 |doi=10.1055/s-0031-1275594 |url=}}</ref> | |||
* Relative contraindications for surgery for osteoporosis include some fracture or defect in posterior aspect of vertebral body and also tumor extension into spinal canal. In case of vertebra plana, a complication of osteoporosis that the height of vertebral body become to one third of its origin, the vertebroplasty procedure is characterized as relative contraindicated; in which high rates of complications may occurred.<ref name="pmid215001312" /> | |||
==== Complications ==== | |||
Potential complications of vertebroplasty for osteoporotic surgical treatment are include cement leakage into other spaces (e.g., paraspinal, intradiskal, and etc.), compression destruction of nerve roots due to cement leakage, pulmonary embolism, cardiac perforation, and adjacent vertebrae fracture.<ref name="pmid21623061">{{cite journal |vauthors=Al-Nakshabandi NA |title=Percutaneous vertebroplasty complications |journal=Ann Saudi Med |volume=31 |issue=3 |pages=294–7 |year=2011 |pmid=21623061 |pmc=3119972 |doi=10.4103/0256-4947.81542 |url=}}</ref> | |||
=== Kyphoplasty === | |||
* Operative interventions include anterior and posterior decompression and stabilization by internal fixation using screws, rods and plates. Failure rate is high because of lack of strength in the osteoporotic bone for stabilization. | * Operative interventions include anterior and posterior decompression and stabilization by internal fixation using screws, rods and plates. Failure rate is high because of lack of strength in the osteoporotic bone for stabilization. | ||
* [[Vertebroplasty]] is a minimally invasive procedure that involves injecting an acrylic compound into the vertebrae to strengthen the bone. The procedure takes one hour, and 70-90% of patients experience relief from back pain after the surgery. | * [[Vertebroplasty]] is a minimally invasive procedure that involves injecting an acrylic compound into the vertebrae to strengthen the bone. The procedure takes one hour, and 70-90% of patients experience relief from back pain after the surgery. | ||
* Balloon [[kyphoplasty]]<ref name="pmid22802993">{{cite journal |author=Bergmann M, Oberkircher L, Bliemel C, Frangen TM, Ruchholtz S, Krüger A |title=Early clinical outcome and complications related to balloon kyphoplasty |journal=Orthop Rev (Pavia) |volume=4 |issue=2 |pages=e25 |year=2012 |month=May |pmid=22802993 |pmc=3395994 |doi=10.4081/or.2012.e25 |url=}}</ref> is indicated in patients with incapacitating vertebral compression fractures, kyphosis or curvature of the spine, and persistent back pain. It can restore the height of the vertebrae and restore some stability to the weakened bone <ref name="pmid14585704">{{cite journal |author=Hendriks JG, van Horn JR, van der Mei HC, Busscher HJ |title=Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection |journal=Biomaterials |volume=25 |issue=3 |pages=545–56 |year=2004 |month=February |pmid=14585704 |doi= |url=}}</ref>. It involves inserting a balloon into the affected vertebrae, inflating it to restore the height of the vertebrae, and then filling the area with an acrylic compound. | * Balloon [[kyphoplasty]]<ref name="pmid22802993">{{cite journal |author=Bergmann M, Oberkircher L, Bliemel C, Frangen TM, Ruchholtz S, Krüger A |title=Early clinical outcome and complications related to balloon kyphoplasty |journal=Orthop Rev (Pavia) |volume=4 |issue=2 |pages=e25 |year=2012 |month=May |pmid=22802993 |pmc=3395994 |doi=10.4081/or.2012.e25 |url=}}</ref> is indicated in patients with incapacitating vertebral compression fractures, kyphosis or curvature of the spine, and persistent back pain. It can restore the height of the vertebrae and restore some stability to the weakened bone <ref name="pmid14585704">{{cite journal |author=Hendriks JG, van Horn JR, van der Mei HC, Busscher HJ |title=Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection |journal=Biomaterials |volume=25 |issue=3 |pages=545–56 |year=2004 |month=February |pmid=14585704 |doi= |url=}}</ref>. It involves inserting a balloon into the affected vertebrae, inflating it to restore the height of the vertebrae, and then filling the area with an acrylic compound. | ||
=== Vesselplasty === | |||
* Hip fractures are treated by open reduction and internal fixation. | * Hip fractures are treated by open reduction and internal fixation. | ||
* Some patients with a hip fracture who are at high risk for another fracture, may benefit from a total hip replacement. | * Some patients with a hip fracture who are at high risk for another fracture, may benefit from a total hip replacement. | ||
Revision as of 20:38, 10 August 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S. [3], Charmaine Patel, M.D. [4]
Overview
Surgical management is employed for fractures caused by osteoporosis. Vertebroplasty and kyphoplasty are used to treat patients with vertebral compression fractures. For fractures of the hip, the surgical method used is called open reduction and internal fixation, or ORIF.
Osteoporosis surgery
- Surgery is not the first-line treatment option for patients with osteoporosis. Osteoporosis is usually reserved for patients with either vertebral or hip fracture in patients, refractory to medical therapy. Surgery options for osteoporosis are very limited.
Vertebroplasty
The procedure was first performed in 1984 by Galibert and Deramond, French neurosurgeons, in order to treat aggressive hemangioma in C2 vertebra. It had very satisfying outcome. The success of this procedure in a favorable way was lead to extend its usage to other destructive bone diseases, such as multiple myeloma, metastatic bone tumors, and also after a while in 1989, its usage for treatment of osteoporotic vertebral fractures was proven.[1]
In any patients that are refractory to long term medical therapy and encountering vertebral compression fracture, vertebroplasty would be a good option. Vertebroplasty is a minimally invasive surgery that is an image-guided by fluoroscopy assistance. In this method some bone cement (mostly polymethylmethacrylate (PMMA)) is injected in the body of vertebra that been fractured. This procedure may lead to improve stability of fractured vertebra, take it back to the normal shape. PMMA injection is done under precise fluoroscopic observation to prevent any leakage of cement into spinal canal. The most important advantages of the vertebroplasty procedure are minimal invasion rather than other open surgical methods, and rapid symptomatic relief compare to other medical treatments.[2]
Vertebroplasty may cause rapid response in patients with osteoporosis. The patients may experience immediate pain and discomfort relief, along with gradual correction of stooped spine (kyphosis) that is occurred because of compression fracture in anterior aspect of vertebrae. The main risk for the procedure is that sometimes the cement injection may compromise the foraminal spaces, leading to radicaular pains.[3]
The mechanism of lowering pain in osteoporotic patients following vertebroplasty is not clear completely. Some of the proposed theories are include correcting micro-fractures, along with vascular, chemical, and also thermal factors. It is assumed that either temperature properties of injected cement destroys pain receptors, or compression effect of the cement crushed the nerve endings in situ.[4]
Whereas, in 2009, Kallmes have found that rapid pain relief and symptomatic cure in osteoporotic patients with vertebral compression fracture are not significantly different from control group.[5]
Indications
Indication for surgery for osteoporosis include osteoporotic patients refractory to medical therapy encountering vertebral fracture.
Contraindications
- Absolute contraindications for surgery for osteoporosis include asymptomatic vertebral fractures and patients with reasonable response to medical therapy, as well as severe coagulopathies or any ongoing local/systemic infection. However, any allergy to the cement or any other materials that may used during the operation are included, too.[6]
- Relative contraindications for surgery for osteoporosis include some fracture or defect in posterior aspect of vertebral body and also tumor extension into spinal canal. In case of vertebra plana, a complication of osteoporosis that the height of vertebral body become to one third of its origin, the vertebroplasty procedure is characterized as relative contraindicated; in which high rates of complications may occurred.[6]
Complications
Potential complications of vertebroplasty for osteoporotic surgical treatment are include cement leakage into other spaces (e.g., paraspinal, intradiskal, and etc.), compression destruction of nerve roots due to cement leakage, pulmonary embolism, cardiac perforation, and adjacent vertebrae fracture.[7]
Kyphoplasty
- Operative interventions include anterior and posterior decompression and stabilization by internal fixation using screws, rods and plates. Failure rate is high because of lack of strength in the osteoporotic bone for stabilization.
- Vertebroplasty is a minimally invasive procedure that involves injecting an acrylic compound into the vertebrae to strengthen the bone. The procedure takes one hour, and 70-90% of patients experience relief from back pain after the surgery.
- Balloon kyphoplasty[8] is indicated in patients with incapacitating vertebral compression fractures, kyphosis or curvature of the spine, and persistent back pain. It can restore the height of the vertebrae and restore some stability to the weakened bone [9]. It involves inserting a balloon into the affected vertebrae, inflating it to restore the height of the vertebrae, and then filling the area with an acrylic compound.
Vesselplasty
- Hip fractures are treated by open reduction and internal fixation.
- Some patients with a hip fracture who are at high risk for another fracture, may benefit from a total hip replacement.
References
- ↑ Lapras C, Mottolese C, Deruty R, Lapras C, Remond J, Duquesnel J (1989). "[Percutaneous injection of methyl-metacrylate in osteoporosis and severe vertebral osteolysis (Galibert's technic)]". Ann Chir (in French). 43 (5): 371–6. PMID 2757346.
- ↑ Hemama M, El Fatemi N, Gana R (2017). "Percutaneous vertebroplasty in Moroccan patients with vertebral compression fractures". Pan Afr Med J. 26: 225. doi:10.11604/pamj.2017.26.225.9872. PMC 5491720. PMID 28690739.
- ↑ El-Fiki M (2016). "Vertebroplasty, Kyphoplasty, Lordoplasty, Expandable Devices, and Current Treatment of Painful Osteoporotic Vertebral Fractures". World Neurosurg. 91: 628–32. doi:10.1016/j.wneu.2016.04.016. PMID 27072339.
- ↑ Cotten A, Boutry N, Cortet B, Assaker R, Demondion X, Leblond D, Chastanet P, Duquesnoy B, Deramond H (1998). "Percutaneous vertebroplasty: state of the art". Radiographics. 18 (2): 311–20, discussion 320–3. doi:10.1148/radiographics.18.2.9536480. PMID 9536480.
- ↑ Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009). "A randomized trial of vertebroplasty for osteoporotic spinal fractures". N. Engl. J. Med. 361 (6): 569–79. doi:10.1056/NEJMoa0900563. PMC 2930487. PMID 19657122.
- ↑ 6.0 6.1 Hargunani R, Le Corroller T, Khashoggi K, Murphy KJ, Munk PL (2011). "Percutaneous vertebral augmentation: the status of vertebroplasty and current controversies". Semin Musculoskelet Radiol. 15 (2): 117–24. doi:10.1055/s-0031-1275594. PMID 21500131.
- ↑ Al-Nakshabandi NA (2011). "Percutaneous vertebroplasty complications". Ann Saudi Med. 31 (3): 294–7. doi:10.4103/0256-4947.81542. PMC 3119972. PMID 21623061.
- ↑ Bergmann M, Oberkircher L, Bliemel C, Frangen TM, Ruchholtz S, Krüger A (2012). "Early clinical outcome and complications related to balloon kyphoplasty". Orthop Rev (Pavia). 4 (2): e25. doi:10.4081/or.2012.e25. PMC 3395994. PMID 22802993. Unknown parameter
|month=ignored (help) - ↑ Hendriks JG, van Horn JR, van der Mei HC, Busscher HJ (2004). "Backgrounds of antibiotic-loaded bone cement and prosthesis-related infection". Biomaterials. 25 (3): 545–56. PMID 14585704. Unknown parameter
|month=ignored (help)