back surgery for osteoporosis. osteoporosis complications prevention. dr. anton titov, md: osteoporosis is a very big problem, especially in the aging population. in your practice you see effects of osteoporosis, the compression fractures. how should people prevent osteoporosis? how to treat osteoporosis? what advice you give to patients regarding this very common condition? dr. eric woodard: sure. osteoporosis can be a very challenging problem for spine surgery. in general, osteoporosis, as you know, is a complicated process. in osteoporosis the bone loses its mineral contents. the bone loses its calcium content. this can be on a genetic basis individually. it can be on the basis of genetic ancestry. typically the scandinavians and the northern europeans are much more prone to osteoporosis than southern europeans or latin americans. so there's clearly a genetic predisposition toward developing osteoporosis. your bones take on and accumulate calcium and phosphate at approximately constant rate to about age 30. and then you slowly lose mineral at a fixed rate. some of this is hormone-based, as you know. and in women once the hormonal changes at menopause occur, they will have an abrupt increase in the rate of loss of mineral of their bone. since the curves are relatively similar in their shape, clearly the higher the mineral content you can achieve up to age thirty, the higher relative amount of mineral you'll have when your age is 60...70...80. so this is the reason behind a strong recommendations and in children and teens and young adults to maximize their nutrition. especially with regard to taking calcium. typically this is done with dairy milk products, things like that. certainly nutritionally depleted or nutritionally deficient individuals in their youth will have higher risk for osteoporosis later. osteoporosis can be devastating in the elderly population who fall below certain thresholds in the spine especially.
dr. eric woodard, md: and this is most typically at the highest stress points in the spine, the midpoint of the thoracic spine, for instance. the vertebrae nearly collapse due to mechanical failure. and when they collapse obviously there is a tremendous amount of associated pain which can be debilitating. in rare cases the collapse associated with narrowing or cord compression. this can be devastating from a neurological standpoint. in recent years there has been a lot of interest in treating osteoporosis aggressively. treatment includes injection of various types of cement into the fracture. or even reducing or essentially re-inflating the vertebrate with percutaneous or needle-based balloons. the cavity is then filled with some cement. that is called a vertebroplasty procedure or a kyphoplasty procedure. both these have been around for a number of years now. vertebroplasty and kyphoplasty are widely practiced. now, just like any treatment, it's only is good until you study it rigorously. some of the more recent rigorous outcome studies have shown only marginal and transient benefit of both vertebroplasty or kyphoplasty. so that it's more of an option rather than a recommendation for folks who have severe symptomatic osteoporosis related fractures. osteoporosis is a particular challenge in folks that have other spine pathologies. especially in patients who we are considering for surgery. we talked about spine surgery indications for deformity, stenosis, and spondylolisthesis. to do standard surgical procedures on these folks with osteoporosis challenges us. because the typical fixation devices that we use for a standard patient prove inadequate in patients with osteoporosis. screws don't hold, many times we have to spread out the stress and make the constructs stronger or even longer. so that there's a mechanical advantage in this very poor area. it is very thin bone that will not hold screws, for instance. dr. eric woodard, md: so osteoporosis is increasing, it's a challenge, it needs to be prevented ideally, and there are a number of options, both surgical and non surgical treatment of these maladies.