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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_6046_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •Preface
- •Contents
- •Contributors
- •References
- •2: Pathophysiology and Epidemiology of Osteoporosis
- •Introduction
- •Bone Structure
- •1: Normal Bone Physiology
- •Osteoclasts
- •Osteoblasts
- •Osteocytes
- •Organic Bone Matrix
- •Inorganic Bone Matrix
- •Biomechanics of Osteoporotic Bone
- •Pathogenesis
- •Calcium and Vitamin D
- •Epidemiology
- •Diseases Leading to Osteoporosis
- •Male Hypogonadism
- •Female Hypogonadism
- •Hematologic Disease
- •Hyperthyroidism
- •Diabetes Mellitus
- •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
- •Introduction
- •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
- •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
- •Fracture Patterns
- •References
- •6: Osteoporotic Vertebral Compression Fractures
- •References
- •Introduction
- •History
- •Physical Examination
- •Imaging
- •Conclusion
- •References
- •Introduction
- •Clinical Presentation
- •History
- •Physical Exam
- •Blood Work
- •Conclusion
- •References
- •Initial Radiologic Evaluation
- •Vertebral Compression Fracture Chronicity
- •Introduction and Imaging Techniques
- •Morphology
- •Marrow Signal Intensity
- •Extravertebral Features
- •Conventional MR: Combined Evaluation of Features
- •Quantitative Evaluation
- •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
- •Pre-AAOS Guideline Evidence
- •AAOS Guidelines
- •Post-AAOS Guidelines
- •Conclusion
- •References
- •13: Vertebroplasty Cement Augmentation Technique
- •Introduction
- •Psychological Treatment
- •References
- •12: Outcomes of Non-operative Management and Vertebral Augmentation of Vertebral Compression Fractures
- •Indication
- •Vertebroplasty Technique
- •Equipment: Bone Needles
- •Needle Placement
- •Equipment: Bone Cements
- •Cement Injection
- •Special Situations
- •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
- •Introduction
- •Evaluation
- •Incidence
- •Pathologic Fracture After Spine Stereotactic Radiosurgery (SRS)
- •Introduction
- •Surgical Stabilization Techniques
- •Minimally Invasive Surgery Approaches
- •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
- •Bisphosphonates Vs. Teriparatide
- •Surgical Techniques to Augment Spinal Instrumentation
- •Proximal Junction Kyphosis (PJK)
- •Current Recommended Management
- •References
- •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
- •Preventing Osteoporotic Vertebral Compression Fractures
- •Treating Osteoporotic Vertebral Compression Fractures
- •References
- •Index

Vertebral Compression
Fractures in Osteoporotic
and Pathologic Bone
A Clinical Guide to
Diagnosis and Management
Afshin E. Razi
Stuart H. Hershman
Editors
123

Vertebral Compression Fractures in
Osteoporotic and Pathologic Bone

Afshin E. Razi • Stuart H. Hershman
Editors
Vertebral Compression
Fractures in
Osteoporotic and
Pathologic Bone
A Clinical Guide toDiagnosis
andManagement

Editors
Afshin E. Razi
Vice Chair and Residency Program
Director
Department of Orthopaedic Surgery
Maimonides Medical Center
Brooklyn, NY
USA
Stuart H. Hershman
Department of Orthopaedic Surgery
Massachusetts General Hospital
Harvard Medical School
Boston, MA
USA
ISBN 978-3-030-33860-2 ISBN 978-3-030-33861-9 (eBook)
https://doi.org/10.1007/978-3-030-33861-9
© Springer Nature Switzerland AG 2020
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specic statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, expressed or implied, with respect to the material
contained herein or for any errors or omissions that may have been made. The publisher remains
neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface
Osteoporosis is a common condition experienced by an ever-growing segment of the population. While it is treated by many different medical disciplines, despite its prevalence, osteoporosis is frequently overlooked until it is
a signicant source of morbidity. Osteoporotic vertebral compression fractures serve as an example of one consequence that can occur as a result of
untreated osteoporosis. All too often, vertebral compression fractures are the
initial nding of osteoporosis, and while this situation occurs commonly,
there is still much ambiguity regarding the subsequent management and treatment of these patients.
Due to a variety of reasons, there is a signicant confusion among specialists as to the ideal management of osteoporotic compression fractures. While
most conditions are treated by one group of specialists, osteoporotic compression fractures are treated by endocrinologists, rheumatologists, orthopedic surgeons, neurosurgeons, interventional radiologists, physiatrists,
anesthesiologists, gynecologists, and primary care physicians. Physicians
from these disciplines typically view the pathology through their own eyes,
relying on their training and expertise to guide treatment. Unfortunately, it is
virtually impossible to have all the knowledge and expertise of clinicians
from other areas of medicine which could perhaps provide a more comprehensive treatment plan. One of our goals in writing this textbook was to help
clarify the optimal management of these patients by presenting some of the
latest literature published on the topic by experts in the various elds which
treat these patients. By including authors from multiple disciplines, we hope
to provide a more thorough treatment algorithm to help clinicians to better
manage these patients, thereby minimizing clinical sequela from an otherwise preventable condition.
Brooklyn, NY, USA AfshinE.Razi, MD
Boston, MA, USA StuartH.Hershman, MD
v

Contents
1 Normal Bone Physiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Henock T. Wolde-Semait and Daniel Komlos
2 Pathophysiology and Epidemiology of Osteoporosis . . . . . . . . . . 9
Nicole M. Stevens and Sanjit R. Konda
3 The Economic Burden of Osteoporosis . . . . . . . . . . . . . . . . . . . . . 21
Harold A. Fogel and Louis G. Jenis
4 Evaluation and Medical Management of Vertebral
Osteoporosis: Preventing the Next Fracture . . . . . . . . . . . . . . . . 31
Faye N. Hant and Marcy B. Bolster
5 Biomechanics of Vertebral Compression Fractures . . . . . . . . . . . 49
Peter J. Ostergaard and Thomas D. Cha
6 Osteoporotic Vertebral Compression Fractures . . . . . . . . . . . . . . 57
Ahmed Saleh and Michael Collins
7 Pathologic Vertebral Compression Fractures: Diagnosis
and Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Daniel G. Tobert and Joseph H. Schwab
8 History, Physical Exam, and Differential Diagnosis
of Vertebral Compression Fracture . . . . . . . . . . . . . . . . . . . . . . . . 69
Michael Dinizo and Aaron Buckland
9 Radiographic Diagnosis of Patients with Vertebral
Compression Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
R. Aaron Marshall and Mohammad Samim
10 Natural History and Long-Term Sequelae of Vertebral
Compression Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
John A. Buza III and Emmanuel Menga
11 Medical, Interventional, and Orthotic Management
of Osteoporotic Vertebral Compression Fractures . . . . . . . . . . . 101
Kartik Shenoy and Yong H. Kim
12 Outcomes of Non-operative Management and Vertebral
Augmentation of Vertebral Compression Fractures . . . . . . . . . . 109
Robert A. McGuire Jr and Joseph M. Zavatsky
vii

viii
13 Vertebroplasty Cement Augmentation Technique . . . . . . . . . . . . 115
A. Orlando Ortiz
14 Kyphoplasty Cement Augmentation Technique . . . . . . . . . . . . . . 137
Robert P. Norton
15 Management of Spinal Deformity in the Setting
of Osteoporotic Vertebral Compression Fractures . . . . . . . . . . . 145
Michael P. Kelly
16 Operative Treatment of Pathologic Compression Fractures
of the Spine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Theodosios Stamatopoulos, Ganesh M. Shankar,
and John H. Shin
17 Osteoporotic Vertebral Compression Fractures Adjacent
to Previous Spinal Fusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Peter G. Passias, Rivka C. Ihejirika-Lomedico, Hesham Saleh,
Max Egers, Avery E. Brown, Haddy Alas, Katherine E. Pierce,
Cole Bortz, and Yael Ihejirika
18 Surgical Strategies in Osteoporotic Bone . . . . . . . . . . . . . . . . . . . 191
Joseph M. Zavatsky and Robert A. McGuire Jr
19 Sacral Insufficiency Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Nicholas Shepard and Nirmal C. Tejwani
Contents
20 Future Treatment Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Hai Le, Umesh Metkar, Afshin E. Razi,
and Stuart H. Hershman
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

Contributors
Haddy Alas, BS Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
Marcy B. Bolster, MD Division of Rheumatology, Allergy, and
Immunology, Massachusetts General Hospital, Harvard Medical School,
Boston, MA, USA
Cole Bortz, BA Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
AveryE. Brown, BS Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
AaronBuckland, MD Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
John A. Buza III, MD, MS Department of Orthopedic Surgery, NYU
Langone Orthopedic Hospital, NYU Langone Medical Center, New York,
NY, USA
Thomas D. Cha, MD, MBA Department of Orthopaedic Surgery,
Massachusetts General Hospital, Harvard Medical School, Boston,
MA, USA
Michael Collins, MD Department of Orthopaedic Surgery, Maimonides
Medical Center, Brooklyn, NY, USA
Michael Dinizo, MD Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, NewYork, NY, USA
Max Egers, BS Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
HaroldA. Fogel, MD Department of Orthopaedic Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
FayeN. Hant, DO, MS CR Division of Rheumatology and Immunology,
Medical University of South Carolina, Charleston, SC, USA
Stuart H. Hershman, MD Department of Orthopaedic Surgery,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
ix

x
RivkaC.Ihejirika-Lomedico, MD Department of Orthopedic Surgery,
NYU Langone Orthopedic Hospital, NYU Langone Medical Center,
New York, NY, USA
Yael Ihejirika, BA Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
LouisG.Jenis, MD, MHCDS Department of Orthopaedic Surgery, NewtonWellesley Hospital, Harvard Medical School, Newton, MA, USA
MichaelP.Kelly, MD, MSc Department of Orthopedic Surgery, Washington
University School of Medicine, Saint Louis, MO, USA
Yong H. Kim, MD Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
DanielKomlos, MD, PhD Department of Orthopaedic Surgery, Maimonides
Medical Center, Brooklyn, NY, USA
SanjitR.Konda, MD Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
HaiLe, MD Department of Orthopaedic Surgery, University of California –
Davis, Davis, CA, USA
R. Aaron Marshall, MD Department of Radiology, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
Contributors
RobertA.McGuire Jr, MD Department of Orthopaedic Surgery, University
of Mississippi Medical Center, Jackson, MS, USA
EmmanuelMenga, MD Department of Orthopaedic Surgery, University of
Rochester Medical Center, Rochester, NY, USA
Umesh Metkar, MD Department of Orthopaedic Surgery, Beth Israel
Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
RobertP.Norton, MD Florida Spine Associates, Boca Raton, FL, USA
A. Orlando Ortiz, MD, MBA, FACR Department of Radiology, Jacobi
Medical Center, Bronx, NY, USA
PeterJ.Ostergaard, MD Department of Orthopaedic Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
PeterG.Passias, MD Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
KatherineE.Pierce, BS Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
Afshin E. Razi, MD Department of Orthopaedic Surgery, Maimonides
Medical Center, Brooklyn, NY, USA
Ahmed Saleh, MD Department of Orthopaedic Surgery, Maimonides
Medical Center, Brooklyn, NY, USA

Contributors
xi
Hesham Saleh, MD Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
MohammadSamim, MD MRCS Department of Radiology, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
JosephH.Schwab, MD Department of Orthopaedic Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
GaneshM.Shankar, MD PhD Department of Neurosurgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
Kartik Shenoy, MD Department of Orthopaedic Surgery, Rothman
Orthopaedic Institute, Philadelphia, PA, USA
NicholasShepard, MD Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
John H. Shin, MD Department of Neurosurgery, Massachusetts General
Hospital, Harvard Medical School, Boston, MA, USA
Theodosios Stamatopoulos, MD, MSc Department of Neurosurgery,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
CORE-Center for Orthopedic Research at CIRI-AUTh, Aristotle University
Medical School, Thessaloniki, Hellas, Greece
NicoleM.Stevens, MD Department of Orthopedic Surgery, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
Nirmal C. Tejwani, MD Department of Orthopedics, NYU Langone
Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
DanielG.Tobert, M.D. Department of Orthopaedic Surgery, Massachusetts
General Hospital, Harvard Medical School, Boston, MA, USA
Henock T.Wolde-Semait, MD Department of Orthopedic Surgery, NYU
Long Island School of Medicine, NYU Langone Health, New York, NY, USA
Joseph M. Zavatsky, M.D. Spine and Scoliosis Specialists, Tampa,
FL, USA
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