Osteoporosis

Spine

AAOS Clinical Practice Guidelines
- Strong
  - AGAINST vetebroplasty
- Moderate
  - Calcitonin 4w for acute and neuro intact
- Limited
  - Kypho is option for symptomatic compression fractures
  - L2 nerve block forr L34 fractures
  - Ibandronate and strontium ranelate vs future
Maximize outcomes in spine surgery
- Prevent osteoporosis most important
- Preop optimization from endo
- Longer fusion construct, don’t star tor end at junction
- 3 points above and below deformity
- Hybrid construct improves fixation strength
- Iliac / sacral fixation in long connnstructs
- Direction of screw affects fixation
- Purchase in subchondral bone is key
- Undertapping increases insertional torque and pullout strength
- Don’t hub the screw
Kypho and Vertebroplasty
- Indication
  - Painful osteoporotic VCF no imrpovements 3 weeeks
  - Patient hospitalized due to painful osteoporotic
  - Painful path fracture
  - Aggressivee hemangioma
  - Kummel disease (AVN of body after compression fracture)
- Absolute contraindication
  - Asymptomatic
  - Hx of VB osteo
  - Allergy to bone fillers
  - Irreverible coagulatophy
- Relative contraindication
  - Radiculopathy
  - Bone retropulse against neual structures
  - 70% height loss
  - Multiple oathologic fractures
  - Lack of surgical backup re: potential complications
- Complications
  - Cementt extravasation
    - Low viscosity, high volume
      - Epidrual in <20
      - Adjacent disk in 20-80%
      - Neuro complications in <1%, but when presen tneeds decompression and recon
  - Embollization
    - Monomer embolizes then polymerizes distally
      - 2-26%
      - CP support
  - New Fracture
    - Inscreased stiffness -> higher loads adjancet seegmentst
    - Evidence does not show inc risk
    - Low BMD, low BMI, intradiscal leakage inc risk
    - 20%
    - Non surgical care vesys operative