Surgical management and decision making in osteoporotic vertebral compression fracture

Abstract

Osteoporotic vertebral compression fracture (OVCF) is a common condition in the elderly. Although it can often be managed conservatively, some patients may experience severe pain, progressive kyphosis, or neurological injury. In these cases, surgical treatment plays a crucial role. Current treatment guidelines, such as those from The German Society of Orthopaedics and Trauma (DGOU), often use the Osteoporotic Fracture (OF) classification based on fracture morphology to guide decisions between conservative and surgical management and to recommend specific operative techniques. Various surgical modalities exist, including cement augmentation (vertebroplasty/kyphoplasty), posterior instrumentation and fusion, and anterior instrumentation and fusion. However, surgery in osteoporotic patients is highly challenging due to an increased risk of implant failure and pseudarthrosis (non-union). The surgeon’s decision-making is critical. This review article will discuss the various studied surgical techniques and the evidence-based, accepted guidelines for managing patients with OVCF.