Treatment of Combined Osteoporotic Compression Fractures and Spinal Stenosis

Abstract

Treatment of osteoporotic compression fractures has rapidly evolved with the use of kyphoplasty and vertebroplasty. Likewise, lumbar spinal stenosis is being treated with less invasive procedures such as interspinous process spacers. The combination of such minimally invasive procedures offers new advantages to selected patients. Evaluation of vertebral augmentation combined with interspinous decompression procedure in the same sitting. We present 2 cases of elderly females who had lumbar compression fractures with back pain, radicular pain and spinal stenosis. Initially, each was treated with an extension brace. In 1 patient, the brace relieved her back pain, but when she would stand or walk, she had severe pain radiating down her left leg preventing mobilization. The other, who lived by herself, had difficulty putting on her brace and did not wear it consistently. On discussion with the patients and their families, the decision was made to proceed with vertebral body augmentation followed by placement of an interspinous process spacer in the same sitting. Both patients had rapid resolution of back and radicular pain. Each has had subsequent compression fractures, but the initially treated levels have remained unchanged. The combination of minimally invasive procedures resulted in rapid pain relief and mobilization in our elderly patients. Although other procedures to decompress the spinal canal, lateral recess and foramen, such as muscle splitting portals with removal of just enough bone to decompress the neural elements, could be advocated, use of an interspinous process spacer achieved the decompression with less dissection, less risk of harm to the thecal sac or nerve roots, minimal blood loss, and operative time. Combining vertebral augmentation and placement of an interspinous process spacer represents a viable option for treating such fragile patients.