Surgical Management of Spinal Conditions in the Elderly Osteoporotic Spine. (October 2015)

• Record Type: Journal Article
• Authors: Goldstein, Christina L.; Brodke, Darrel S.; Choma, Theodore J.
• Other Names: Fehlings Michael G. section editor.; Mroz Thomas section editor.; Choma Theodore J. section editor.; Harrop James S. section editor.
• Is Part Of: Neurosurgery. Volume 77:(2015)Supplement 1
• Publication Date: 2015-10
• Subjects: Cement augmentation -- Instrumentation -- Osteopenia -- Osteoporosis -- Pedicle screws -- Proximal junctional failure -- Spine implants; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000000948
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract : Osteoporosis, the most common form of metabolic bone disease, leads to alterations in bone structure and density that have been shown to compromise the strength of spinal instrumentation. In addition, osteoporosis may contribute to high rates of fracture and instrumentation failure after long posterior spinal fusions, resulting in proximal junctional kyphosis and recurrent spinal deformity. As increasing numbers of elderly patients present for surgical intervention for degenerative and traumatic spinal pathologies, current and future generations of spine surgeons will increasingly be faced with the challenge of obtaining adequate fixation in osteoporotic bone. The purpose of this review is to familiarize the reader with the impact of osteoporosis on spinal instrumentation, the broad variety of techniques that have been developed for addressing these issues, and the biomechanical and clinical evidence in support of the use of these techniques. ABBREVIATIONS: BMD, bone mineral density HA, hydroxyapatite PJF, proximal junctional failure PJK, proximal junctional kyphosis UIV, upper instrumented vertebrae