Dear Editor,
We read with great interest the recent article by Hosogane et al., “Surgical Treatment of Osteoporotic Fracture with Neurological Deficit―A Nationwide Multicenter Study in Japan”1). The article concludes that “substantial improvement in activity of daily living was achieved by fusion surgery” for patients with osteoporotic vertebral compression fractures. Although we agree with the benefits fusion surgery offer to patients with osteoporotic vertebral fractures (OVFs), the article did not mention minimally invasive and conservative treatment options for these fracture patterns.
OVFs are common entities mostly seen in the elderly female population. Advancements in the medical field have led to an aging population and, therefore, an increased incidence of OVF in the general population2). Timely and appropriate treatment of these fractures is vital to preserve a patient's quality of life and to reduce mortality. Some nonsurgical treatments include bed rest, opioid analgesia, and muscle relaxants, whereas one of the most popular minimally invasive interventions is the balloon kyphoplasty3).
Open surgical approaches do offer another option to patients with OVF; however, they are more invasive procedures. Since OVFs are primarily seen in the elderly population, comorbidities and frailty are of major concern. In a recent study analyzing 2,320 patients over the age of 80 who underwent lumbar spine surgery, instrumentation and fusion procedures were associated with increased complication rates4).
Overall, open spinal surgeries are clearly associated with significant morbidity, especially for the elderly population. In this regard, OVF should be first managed as conservatively as possible with nonsurgical and minimally invasive approaches including vertebral stabilization such as balloon kyphoplasty. Fusion surgery should then be considered if a patient does not respond to conservative therapy or the disease progresses to involve neurological compromise.
Conflicts of Interest: The authors declare that there are no relevant conflicts of interest.
footnotes
This comment refers to the article available at doi:10.22603/ssrr.2019-0004.
Author's reply to this comment is available at doi:10.22603/ssrr.2020-0033.
References
- 1.Hosogane N, Nojiri K, Suzuki S, et al. Surgical Treatment of Osteoporotic Vertebral Fracture with Neurological Deficit―A Nationwide Multicenter Study in Japan―. Spine Surgery and Related Research. 2019;3(4):361-7. https://doi.org/10.22603/ssrr.2019-0004 [DOI] [PMC free article] [PubMed]
- 2.Li HM, Zhang RJ, Gao H, et al. New vertebral fractures after osteoporotic vertebral compression fracture between balloon kyphoplasty and nonsurgical treatment PRISMA. Medicine. 2018;97(40):e12666. doi: 10.1097/MD.0000000000012666 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Lyritis GP, Mayasis B, Tsakalakos N, et al. The natural history of the osteoporotic vertebral fracture. Clinical Rheumatology. 1989;8(2 Supplement):66-9. https://doi.org/10.1007/BF02207237 [DOI] [PubMed]
- 4.Saleh A, Thirukumaran C, Mesfin A, et al. Complications and readmission after lumbar spine surgery in elderly patients: an analysis of 2,320 patients. Spine Journal. 2017;17(8):1106-12. https://doi.org/10.1016/j.spinee.2017.03.019 [DOI] [PubMed]