Surgical decision making in osteoporotic vertebral fractures

Description

Dennis Dominguez presents an overview of multidisciplinary management of osteoporotic vertebral fractures, emphasising that the real clinical issue often begins with low back pain in older adults rather than the fracture itself. He explains that in patients over 50, especially after low-energy trauma, osteoporotic fracture should be strongly suspected, since prevalence and fracture risk rise sharply with age and osteoporosis-related bone and muscle weakness. He discusses diagnostic challenges, noting that standard X-rays can miss many spinal injuries, while CT has much higher sensitivity, and that standing X-rays are important to detect kyphotic deformity that supine imaging may hide. He reviews the OF (osteoporotic fracture) classification, from OF1 visible only on MRI to OF5 with posterior element involvement, and points out that kyphotic deformity is not captured by the classification. Dominguez proposes an algorithm in which suspected patients undergo CT first, then standing X-ray, with conservative treatment for deformity under 15 degrees and surgical evaluation for greater deformity. OF4 fractures may be treated with minimally invasive vertebral reconstruction such as SpineJack and cement augmentation, while OF5 fractures require posterior fixation as well. He argues that treatment decisions should consider stability, biology, and function, and stresses the importance of addressing the underlying osteoporosis with a bone disease specialist to prevent the vertebral fracture cascade. The talk includes discussion of evidence, controversy, and regional differences in practice, with audience members debating whether aggressive intervention is warranted versus conservative follow-up and systemic osteoporosis management. Dominguez concludes that clinicians should use objective classification-based decision-making, pursue close collaboration with bone specialists, and continue research to better define outcomes for conservative versus surgical treatment.

DOI: 10.1302/3114- 26 1312

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