Chaddha Ram, Agrawal Gaurav, Tikoo Agnivesh, Kotadia Harsh
Lilavati Hospital and Research Centre, A-791, Bandra Reclamation Road, General Arunkumar Vaidya Nagar, Bandra West, Mumbai, Maharashtra 400050 India.
Centre for Bone and Joint Care, Kokilaben Dhirubhai Ambani Hospital, Rao Saheb Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, Maharashtra 400053 India.
Indian J Orthop. 2025 Jan 21;59(3):368-381. doi: 10.1007/s43465-024-01333-x. eCollection 2025 Mar.
Osteoporotic vertebral fractures are exponentially impacting health-care systems globally with the rapid increase in geriatric population. These fractures are seen most commonly in the dorso-lumbar spine. Lack of timely diagnosis and adequate treatment contributes significantly to morbidity and mortality. It has become vital to thoroughly evaluate these patients clinically, investigate them, optimise them, plan conservative and / or surgical treatment and provide comprehensive pre, peri and post-operative counselling and support.
Historically, geriatric patients with multiple comorbidities with vertebral fractures were considered poor candidates for surgical treatment due to high anaesthetic and surgical risk. Those who were offered surgery were not adequately optimised pre-operatively and the fractures were under-stabilised surgically. Better understanding of the biomechanics of an osteoporotic vertebral column with dorso-lumbar fractures, combined with advances in anaesthetic and surgical techniques, implants and technologies facilitate successful surgeries on high-risk geriatric patients significantly reducing morbidity and improving quality of life. This article discusses the pathophysiology of dorso-lumbar osteoporotic vertebral fractures, their clinical presentation, investigative work-up, pre-operative optimization, indications for surgical intervention, various surgical modalities, techniques and technologies for optimal surgical outcomes, post-operative care and follow-up of patients.
In this article, the authors aim to provide an overview of the various pre, peri and postoperative considerations while dealing with patients of osteoporotic dorso-lumbar vertebral fractures. This review provides a comprehensive set of guidelines for the medical optimization and surgical management of these patients with an overview of current techniques, strategies and technologies designed to address the challenges associated with spine surgery in geriatric comorbid osteoporotic patients.
Content for this article has been sourced from routinely cited articles available via PubMed, National Institute of Health, census reports from United Nations, from previous articles by the authors and from the protocols established by the authors in their clinical practice based on experience and detailed case reviews.
随着老年人口的迅速增加，骨质疏松性椎体骨折对全球医疗保健系统的影响呈指数级增长。这些骨折最常见于胸腰椎。缺乏及时诊断和充分治疗会显著增加发病率和死亡率。对这些患者进行全面的临床评估、检查、优化、规划保守和/或手术治疗，并提供全面的术前、术中和术后咨询与支持变得至关重要。
从历史上看，患有多种合并症且伴有椎体骨折的老年患者因麻醉和手术风险高而被认为不适合手术治疗。那些接受手术的患者术前没有得到充分优化，骨折手术固定不充分。对伴有胸腰椎骨折的骨质疏松性脊柱生物力学的更好理解，结合麻醉和手术技术、植入物及技术的进步，有助于对高危老年患者成功实施手术，显著降低发病率并改善生活质量。本文讨论胸腰椎骨质疏松性椎体骨折的病理生理学、临床表现、检查、术前优化、手术干预指征、各种手术方式、实现最佳手术效果的技术和工艺、术后护理及患者随访。
在本文中，作者旨在概述处理骨质疏松性胸腰椎椎体骨折患者时术前、术中和术后的各种注意事项。本综述为这些患者的医学优化和手术管理提供了一套全面的指南，概述了当前旨在应对老年合并骨质疏松患者脊柱手术相关挑战的技术、策略和工艺。
本文内容来源于通过PubMed、美国国立卫生研究院可常规引用的文章、联合国人口普查报告、作者以前的文章以及作者在临床实践中基于经验和详细病例回顾制定的方案。
