title: Kyphoplasty for vertebral augmentation in the elderly with osteoporotic vertebral compression fractures: scenarios and review of recent studies.
abstract: BACKGROUND
  Vertebral compression fractures caused by osteoporosis are among the most common fractures in the elderly. The treatment focuses on pain control, maintenance of independence, and management of the osteoporosis. Elderly patients often encounter adverse effects to pain medications, do not tolerate bed rest, and are not ideal candidates for invasive spinal reconstructive surgery. Percutaneous vertebral augmentation (vertebroplasty or kyphoplasty) has become popular as a less-invasive alternative. However, studies have questioned the effectiveness of these procedures.
  
  
  METHODS
  The authors conducted a MEDLINE search using relevant search terms including osteoporosis, osteoporotic vertebral compression fracture, elderly, kyphoplasty and vertebroplasty.
  Two elderly patients presented with a fracture of their third and first lumbar vertebral body, respectively. One patient progressed well with conservative treatment, whereas the other patient was hospitalized secondary to pain after conservative measures failed to offer improvement. The hospitalized patient subsequently opted for a kyphoplasty and was able to resume his normal daily activities after the procedure.
  
  
  CONCLUSIONS
  Selecting patients on an individual case-by-case basis can optimize the effectiveness and outcomes of a vertebral augmentation. This process includes the documentation of an osteoporotic vertebral compression fracture with the aide of imaging studies, including the acuity of the fracture as well as the correlation with the physical examination findings. Patients who are functional and improving under a conservative regimen are not candidates for kyphoplasty. However, if the conservative management is not successful after 4 to 6 weeks and the patient is at risk to become bedridden, an augmentation should be considered. A kyphoplasty procedure may be preferred over vertebroplasty, given the lower risk profile and better outcomes regarding spinal alignment.
authors.affiliation: Department of Anesthesiology, Division of Pain Medicine, University of Texas Medical Branch, Galveston, Texas.
authors.forename: Timothy
authors.initials: T
authors.lastname: Bednar
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Heyde
authors.forename: Grace
authors.initials: G
authors.lastname: Bednar
authors.forename: David
authors.initials: D
authors.lastname: Nguyen
authors.forename: Elena
authors.initials: E
authors.lastname: Volpi
authors.forename: Rene
authors.initials: R
authors.lastname: Przkora
mesh_terms: D000368:Aged; D005260:Female; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty / Q000009:adverse effects / Q000191:economics; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000601:surgery*; D059408:Pain Management; D016103:Spinal Fractures / Q000601:surgery*; D016896:Treatment Outcome
keywords: elderly; kyphoplasty; osteoporosis; vertebral augmentation; vertebral compression fracture; vertebroplasty