Techniques For The Osteoporotic Spine That Needs Fusion

Abstract

Degenerative disorders of the spine associated with osteoporosis and issues related to instrumentation have shown a dramatic rise over the past years as spinal fusion is a common surgery. For the spine surgeon, the limited holding power of implants in the osteoporotic spine represents a critical point especially in cases of instability or deformity. Optimizing effectiveness of implants in osteoporotic bone may be achieved by cement augmentation. A vertebroplasty procedure prior to the screw placement and the use of perforated implants with direct cement injection are useful alternatives. For deformity correction in the elderly the lateral transpsoas approach avoids the morbidity related to multilevel screw fixation, but a risk of cage subsidence that can be addressed with a protective vertebroplasty exists. In cases of segmental instabilities, anterior column support by a discoplasty procedure-the injection of PMMA into the intervertebral void-in combination with a pedicular stabilization and fusion provides an alternative solution for the osteoporotic spine.