Procedure of the Month

You chose: Surgical intervention with internal fixation devices. - WRONG

Typical cases requiring surgical intervention with internal fixation are either showing signs of compromised spinal elements (i.e.; stenosis), misalignment of vertebral bodies (spondylolisthesis) and/or cases of intractable back pain unresponsive to conservative care, as observed in cases of advanced degenerative disc disease (DDD). In addition, young patients with vertebral fractures might be treated via corpectomy.

The operative trauma, however, can be avoided in older patients with vertebral fractures. These patients are often osteoporotic, and as such, may not have the appropriate bone stock for internal fixation devices. Their tolerance for operative trauma may be limited and thus result in a high rate of post-operative adverse events. In addition, these elderly patients may develop a so-called “dowager’s hump” deformity following surgery with internal fixation.

Older patients with vertebral compression fractures, as seen in this case, do not show evidence of compromised spinal elements and are experiencing pain specifically because of the bone-on-bone motion within the fractured vertebral body. In these cases, the pain can be significantly alleviated by simply eliminating all motion at the fractured site. This can be accomplished by using vertebral body augmentation, a percutaneous minimally invasive procedure.

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