Surgical Treatment of Pathologic Spinal Fractures in Osteoporosis: Two Clinical Cases

Osteoporotic spine fractures are among the most prevalent fractures in patients with osteoporosis and pose significant challenges to surgical treatment. Achieving stable fixation of osteoporotic bone is technically challenging and has become an increasing concern in spinal neurosurgery in the aging global population. Numerous studies have described the biomechanical benefits of fixation devices and techniques; however, no standard of care has been identified to provide distinct spinal stabilization in these patients. This study reviews the existing evidence and explores the complexities related to the treatment of pathologic spinal fractures in the context of systemic osteoporosis. Description of clinical cases: We present 2 cases of pathologic osteoporotic spinal fractures with spinal canal compression treated surgically using a modified method that incorporates cemented cannulated transpedicular screws and interbody spondylodesis with cage placement. Patients were followed up for 24 months after surgery. The Visual Analog Scale score improved significantly, decreasing from 7.3 points before surgery to 1.2 points immediately after surgery and to 0.5 points at the end of the follow-up. Similarly, the Oswestry Disability Index improved from 69% before surgery to 41% immediately after surgery and to 20% after 2 years. The Cobb angle improved from 38.0° preoperatively to 29.0° immediately after surgery. No bone resorption around the screws was observed during follow-up. The combination of transpedicular fixation with vertebroplasty is safe and effective for treating osteoporotic spinal fractures. This approach yields satisfactory clinical and radiographic results.