Περίληψη:
Osteoporosis is the most common contributing factor of spinal fractures,
which characteristically are not generally known to produce spinal cord
compression symptoms. Recently, an increasing number of medical reports
have implicated osteoporotic fractures as a cause of serious
neurological deficit and painful disabling spinal deformities. This has
been corroborated by the present authors as well. These complications
are only amenable to surgical management, requiring instrumentation.
Instrumenting an osteoporotic spine, although a challenging task, can be
accomplished if certain guidelines for surgical techniques are
respected. Neurological deficits respond equally well to an anterior or
posterior decompression, provided this is coupled with multisegmental
fixation of the construct. With the steady increase in the elderly
population, it is anticipated that the spine surgeon will face serious
complications of osteoporotic spines more frequently. With regard to
surgery, however, excellent correction of deformities can be achieved,
by combining anterior and posterior approaches. Paget’s disease of bone
(PD) is a non-hormonal osteometabolic disorder and the spine is the
second most commonly affected site. About one-third of patients with
spinal involvement exhibit symptoms of clinical stenosis. In only
12-24% of patients with PD of the spine is back pain attributed solely
to PD, while in the majority of patients, back pain is either arthritic
in nature or a combination of a pagetic process and coexisting
arthritis. In this context, one must be certain before attributing low
back pain to PD exclusively, and antipagetic medical treatment alone may
be ineffective. Neural element dysfunction may be attributed to
compressive myelopathy by pagetic bone overgrowth, pagetic intraspinal
soft tissue overgrowth, ossification of epidural fat, platybasia,
spontaneous bleeding, sarcomatous degeneration and vertebral fracture or
subluxation. Neural dysfunction can also result from spinal ischemia
when blood is diverted by the so-called “arterial steal syndrome”.
Because the effectiveness of pharmacologic treatment for pagetic spinal
stenosis has been clearly demonstrated, surgical decompression should
only be instituted after failure of antipagetic medical treatment.
Surgery is indicated as a primary treatment when neural compression is
secondary to pathologic fractures, dislocations, spontaneous epidural
hematoma, syringomyelia, platybasia, or sarcomatous transformation. Five
classes of drugs are available for the treatment of PD. Bisphosphonates
are the most popular antipagetic drug and several forms have been
investigated.
Συγγραφείς:
Hadjipavlou, AG
Katonis, PG
Tzermiadianos, MN
Tsoukas, GM
and Sapkas, G
