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Ayoub Dakson, MBChB, MSc, FRCSC,1 Sean Christie, MD, FRCSC,2

1Clinical Fellow, Department of Surgery (Neurosurgery) QEII Health Sciences Centre, Halifax, Nova Scotia.2Professor, Department of Surgery (Neurosurgery), QEII Health Sciences Centre, Halifax, Nova Scotia.

CLINICAL TOOLS

Abstract:Pathological vertebral fractures (PVFs) occur commonly due to osteoporosis or a metastatic lesion to the spine, and present with acute back pain and loss of independent ambulation. Appropriate clinical assessment and radiographic evaluation are required to ensure optimal patient selection for a percutaneous vertebral augmentation procedure (PVA). This review explores the pathogenesis of PVFs and the efficacy of PVA in improving pain-related outcomes as well as health-related quality of life scores in both osteoporotic and metastatic PVFs.
Key Words: Osteoporosis; pathological vertebral fractures; vertebroplasty; kyphoplasty.

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Pathological vertebral fractures occur commonly due to osteoporosis and metastatic disease to the spine.
Percutaneous vertebral augmentation procedures consist of vertebroplasty or balloon-kyphoplasty with the goals of increasing the strength of fractured vertebral body and restoring its height in order to alleviate back pain and increase ambulation.
Balloon-kyphoplasty has been shown to improve back pain associated with PVFs and health-related quality of life scores.
Appropriate consideration of ''red flag'' features in the clinical history and neurologic examination of a patient with back pain is crucial in screening for a potential sinister underlying etiology (i.e. malignant pathological vertebral fractures with spinal cord compression, infection, etc.).
MRI imaging (STIR) may provide useful information in deciding if the fracture has already healed.
Loss of the integrity of the dorsal wall of the fractured vertebral body increases the risk of leakage of the injected cement into the spinal canal, potentially causing spinal cord compression.
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