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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 toDiagnosis andManagement
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, specically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microlms 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 specic 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 afliations.
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 signicant 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 signicant 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 AfshinE.Razi, MD Boston, MA, USA StuartH.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
AveryE. Brown, BS Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
AaronBuckland, 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, NewYork, NY, USA
Max Egers, BS Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
HaroldA. Fogel, MD Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
FayeN. 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
RivkaC.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
LouisG.Jenis, MD, MHCDS Department of Orthopaedic Surgery, Newton­Wellesley Hospital, Harvard Medical School, Newton, MA, USA
MichaelP.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
DanielKomlos, MD, PhD Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA
SanjitR.Konda, MD Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
HaiLe, 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
RobertA.McGuire Jr, MD Department of Orthopaedic Surgery, University of Mississippi Medical Center, Jackson, MS, USA
EmmanuelMenga, 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
RobertP.Norton, MD Florida Spine Associates, Boca Raton, FL, USA
A. Orlando Ortiz, MD, MBA, FACR Department of Radiology, Jacobi
Medical Center, Bronx, NY, USA
PeterJ.Ostergaard, MD Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
PeterG.Passias, MD Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
KatherineE.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
MohammadSamim, MD MRCS Department of Radiology, NYU Langone Orthopedic Hospital, NYU Langone Medical Center, New York, NY, USA
JosephH.Schwab, MD Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
GaneshM.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
NicholasShepard, 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
NicoleM.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
DanielG.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