Management of osteoporotic fractures of the thoracolumbar spine

Approximately 2 million people sustain an osteoporotic fracture in the United States each year; 25% of those are vertebral compression fractures. Most fractures can be treated nonoperatively, using a combination of bracing, physical therapy, and pain medications. Surgical treatment may be considered for patients with severe pain or who have failed nonoperative options. Surgical treatment options include vertebroplasty and kyphoplasty, which involve the injection of bone cement (polymethylmethacrylate) to augment vertebral bone strength; kyphoplasty adds the inflation of a balloon tamp to help reduce the fracture and create a space for the cement. The risk of cement extravasation is relatively high, especially during vertebroplasty; however, the incidence of symptomatic leaks is relatively low. Overall, both procedures offer low complication rates, excellent pain relief, and improved function after vertebral compression fractures.