Vertebral Compression Fractures in Osteoporotic and Pathologic Bone: A Clinical Guide to Diagnosis and Management

Preface
Contents
Contributors
1: Normal Bone Physiology
	Osteoclasts
	Osteoblasts
	Osteocytes
	Bone Growth and Remodeling
	Organic Bone Matrix
	Inorganic Bone Matrix
	Updates on Bone Physiology
	Age-Related Changes in Bone
	References
2: Pathophysiology and Epidemiology of Osteoporosis
	Introduction
	Definition of Osteoporosis
	Bone Structure
	Biomechanics of Osteoporotic Bone
	Pathogenesis
		Calcium and Vitamin D
		Estrogen Deficiency
	Epidemiology
	Diseases Leading to Osteoporosis
		Male Hypogonadism
		Female Hypogonadism
		Chronic Inflammatory Disease
		Hematologic Disease
		Hyperthyroidism
		Diabetes Mellitus
		Human Immunodeficiency Virus (HIV)
		Glucocorticoid Excess
	Medications Causing Osteoporosis
		Exogenous Steroids
		Aromatase Inhibitors
		Acid Suppressive Medications
		Antiepileptic Drugs
		Selective Serotonin Uptake Inhibitors (SSRIs)
	Lifestyle Factors
		Smoking
		Chronic Alcohol Abuse
	Recommended Screening for Osteoporosis
	Recognition of Patients at Risk
	References
3: The Economic Burden of Osteoporosis
	Introduction
	Epidemiology and Implications of Osteoporotic Spine Disease
	Direct and Indirect Medical Costs of Osteoporotic Spine Disease
	Determining Outcomes in the Treatment of Osteoporosis.
	The Value of Preventative Care in Osteoporosis.
	The Future of Treating Osteoporosis.
	References
4: Evaluation and Medical Management of Vertebral Osteoporosis: Preventing the Next Fracture
	Introduction
	Epidemiology
	Risk Factors for Vertebral Fracture
	Societal Impact of Osteoporosis and Vertebral Fractures
	Diagnostic Approach
	Risk Factor Modification
	Diet, Calcium and Vitamin D Intake
	Medical Management
	Pharmacologic Management
	Oral Bisphosphonates
	Rank Ligand Inhibition
	Estrogen Agonist/Antagonist (Formerly Known as SERMs)
	Anabolic Agents
	Summary
	References
5: Biomechanics of Vertebral Compression Fractures
	Microstructure of the Vertebral Body
	Microstructure of the Intervertebral Disc
	Creep Deformity and Fatigue Failure
	Fracture Patterns
	Mechanism of Pain in Vertebral Compression Fractures
	References
6: Osteoporotic Vertebral Compression Fractures
	References
7: Pathologic Vertebral Compression Fractures: Diagnosis and Management
	Introduction
	Metastatic Disease in the Spine
	Diagnosis of Pathologic Vertebral Compression Fractures
		History
		Physical Examination
		Imaging
	Management of Pathologic Vertebral Compression Fractures
	Conclusion
	References
8: History, Physical Exam, and Differential Diagnosis of Vertebral Compression Fracture
	Introduction
	Clinical Presentation
		History
		Physical Exam
	Differential Diagnosis
	Blood Work
	Conclusion
	References
9: Radiographic Diagnosis of Patients with Vertebral Compression Fractures
	Initial Radiologic Evaluation
	Imaging Definition of Vertebral Compression Fracture
	Vertebral Compression Fracture Chronicity
	Differentiating Benign Versus Pathologic Fractures
		Introduction and Imaging Techniques
		Morphology
		Marrow Signal Intensity
		Extravertebral Features
		Conventional MR: Combined Evaluation of Features
		Quantitative Evaluation
		Diffusion-Weighted Imaging
		Chemical Shift Imaging
		Dynamic Contrast-Enhanced Imaging
	Evaluation When MRI Is Contraindicated
	References
10: Natural History and Long-Term Sequelae of Vertebral Compression Fractures
	Introduction
	Presentation of Vertebral Compression Fracture
	Pain Associated with Acute Vertebral Compression Fracture
	Physical Consequences of Vertebral Compression Fracture
	Disability After Vertebral Compression Fracture
	Risk of Subsequent Fracture Following Vertebral Compression Fracture
	Conclusion
	References
11: Medical, Interventional, and Orthotic Management of Osteoporotic Vertebral Compression Fractures
	Introduction
	Pharmacologic Treatment
	Injections
	Bracing
	Psychological Treatment
	References
12: Outcomes of Non-operative Management and Vertebral Augmentation of Vertebral Compression Fractures
	Pre-AAOS Guideline Evidence
	AAOS Guidelines
	Post-AAOS Guidelines
	Conclusion
	References
13: Vertebroplasty Cement Augmentation Technique
	Introduction
	Indication
	Vertebroplasty Technique
		Equipment: Bone Needles
		Needle Placement
		Equipment: Bone Cements
		Cement Injection
	Special Situations
	Vertebroplasty Complications and Their Treatment
	Conclusions
	References
14: Kyphoplasty Cement Augmentation Technique
	Indications
	Technique
	Tips
	Multilevel Compression Fractures
	Complications
	References
15: Management of Spinal Deformity in the Setting of Osteoporotic Vertebral Compression Fractures
	Introduction
		Evaluation
		Radiographic Examination
	Medical Management
	Surgical Management
		Postoperative Care
	Conclusion
	Bibliography
16: Operative Treatment of Pathologic Compression Fractures of the Spine
	Introduction
	Evaluation
		Incidence
		Clinical Significance
	Pathologic Fracture After Spine Stereotactic Radiosurgery (SRS)
	Medical Management and Optimization
		Introduction
		Clinical Characteristics of Pathologic Spine Fractures
		Pain Associated with Spine Tumors
		Signs and Symptoms of VCF
			Craniovertebral Junction: Occipital Condyle to C2
			Subaxial Cervical Spine: C3 to C6
			Cervicothoracic: C7 to T2
			Thoracic and Lumbar Spine: T3 to L5
		Radiographic Diagnosis of Pathological Fractures of the Spine
		Assessment of Spine Stability in Cancer: SINS (Spinal Instability Neoplastic Score)
			Concept of SINS
			SINS in Clinical Practice
		Surgical Management of Common Pathologies
		Surgical Considerations: Cervical Spine and Cervicothoracic Junction
			Vertebroplasty and Kyphoplasty
	Surgical Stabilization Techniques
		Thoracic and Lumbar Spine: T3–L5
		New Techniques for Stabilization: Fenestrated Pedicle Screws
		Minimally Invasive Surgery Approaches
	Conclusion and Expert Opinion
	References
17: Osteoporotic Vertebral Compression Fractures Adjacent to Previous Spinal Fusion
	Evaluation
		Introduction
		Mechanisms of Proximal Junctional Fracture
		Risk Factors for VCF
	Medical Management
	Surgical Management
	Considerations
	References
18: Surgical Strategies in Osteoporotic Bone
	Background
	DEXA (T-Score) Vs. Spinal Computed Tomography (Hounsfield Unit (HU))
	Bisphosphonates Vs. Teriparatide
	Surgical Techniques to Augment Spinal Instrumentation
	Proximal Junction Kyphosis (PJK)
	Current Recommended Management
	References
19: Sacral Insufficiency Fractures
	Introduction
	Incidence
	Anatomy and Biomechanics
	Risk Factors
	Clinical Presentation and Evaluation
	Imaging
		Plain Radiographs
		Computed Tomography (CT)
		Magnetic Resonance Imaging (MRI)
		Bone Scintigraphy
	Treatment Options
		Conservative Management
		Medical Management
		Surgical Management
			Screw Fixation
			Sacroplasty
			Posterior (Short-Axis) Technique
			Long-Axis Technique [90]
	References
20: Future Treatment Strategies
	Introduction
	Screening Patients at Risk of Osteoporosis
		Current and Future Screening Tests
	Preventing Osteoporotic Vertebral Compression Fractures
		Current and Future Medical Therapies
	Treating Osteoporotic Vertebral Compression Fractures
		Current and Future Surgical Options
	References
Index