SPINE SURGERY FOR OSTEOPOROTIC VERTEBRAL FRACTURES: LONG TERM FOLLOW-UP
Osteoporosis represents a worldwide problem due to under diagnosis, and under treatment. The major complications are fragility fractures as vertebral, etc. some of them requiring orthopedic and neurosurgical procedures. We introduce a case of a female adult who was first referred for spine surgery because of osteoporosis complications and then she was followed for a few years based on background skeleton condition. This is a 70-year old subject admitted for a new vertebral fracture assessment and therapy adjustment. She had 3 spine surgeries for multiple vertebral fractures (thoracic 7, 8, 9,10, and 12) during the last 5 years; she was intermittently treated with specific anti-osteoporotic drugs. On admission, the patient has severe kyphosis and secondary walk difficulties; intermittent non-specific lumbar pain. The mineral metabolism indicated no anomaly. DXA confirmed low T-score with reduced values compare to prior analysis. X-Ray assays at spine levels showed diffuse demineralization, multiple metallic implants at the level of thoracic vertebras T7, 8, 9, 10, 12 and another new one at T7, round kyphosis, increased physiological lordosis; osteophytosis including at hip joint. The patient was offered a yearly intravenous injection of zolendronic acid 5 mg in addition to 2000 Units of cholecalciferol and 800 units of calcium per day. Another spine surgery was considered unnecessary for the moment, but close follow-up is useful, including the management regarding therapy and lifestyle intervention for severe osteoporosis. The management of a patient with osteoporotic spine fracture is a complex and dynamic equation requiring a multidisciplinary team and life time follow-up.