Jang Hae-Dong, Kim Eung-Ha, Lee Jae Chul, Choi Sung-Woo, Kim Kyungbum, Shin Byung-Joon
Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea.
Asian Spine J. 2020 Dec;14(6):898-909. doi: 10.31616/asj.2020.0594. Epub 2020 Dec 22.
Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%-35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.
椎体骨折是最常见的骨质疏松性骨折类型，可增加发病率和死亡率。迄今为止，骨质疏松性椎体骨折（OVF）的管理指南在数量和质量上都很有限，且这些骨折尚无金标准治疗方法。保守治疗被认为是OVF的主要治疗选择，包括通过短期卧床休息、镇痛药、抗骨质疏松药物、运动和支具来缓解疼痛。关于椎体强化（VA）（包括椎体成形术和后凸成形术）的研究已有广泛报道，但与保守治疗相比，VA的有效性仍存在争议，目前证据不支持将VA常规用于OVF。尽管大多数OVF愈合良好，但约15%-35%的不稳定骨折、慢性顽固性背痛、严重塌陷椎体（导致神经功能缺损和脊柱后凸）或慢性假关节患者经常需要手术。鉴于在OVF中没有单一技术可优化手术效果，因此需要量身定制的手术技术。外科医生需要关注骨质疏松性脊柱手术的进展，并应接受新思想和新技术。骨质疏松症的预防和管理是降低后续OVF风险的关键因素。双膦酸盐和特立帕肽是改善OVF骨折愈合的主要药物。双膦酸盐对骨折愈合的影响尚未进行临床评估。间歇性给予特立帕肽可显著增强脊柱融合和骨折愈合，并降低死亡风险。基于当前文献，OVF仍缺乏标准的管理策略。需要通过包括保守治疗、手术、骨质疏松症治疗以及促进骨折愈合的药物等多模式方法做出更大努力，以提高指南的质量。
