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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 94

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Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 94. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Osteoporotic Spine Fractures Chapter 32 929 Distribution of bone mineral density BMD in healthy women aged 30-40 years 46 . Figure 2. Bone mineral density ence population. This so-called T-score is the number of SDs that the bone density is above or below the average value for the reference population. Four general diagnostic categories have been distinguished normal BMD equal to or more than -1 SD T-score -1 osteopenia BMD between -1 SD and -2.5 SD T-score -1 osteoporosis BMD less than -2.5 SD T-score -2.5 severe osteoporosis BMD less than -2.5 SD in the presence of one or more fragility fractures. For diagnosis measurements of BMD at the hip and the lumbar spine are the gold standard. Besides the diagnostic use of bone densitometry these measurements have an additional prognostic value with respect to fracture probability the age-adjusted relative increase in risk e.g. of vertebral fracture is 2.3 for every one SD decrease in lumbar BMD 61 . BMD can be differentiated into four categories Classification of Vertebral Body Compression Fractures Unlike traumatic fractures osteoporotic vertebral body fractures can be difficult to diagnose on conventional radiographs. The fracture patterns often do not fit into fracture classifications known from spinal trauma 60 . For this purpose morphometric criteria were established for diagnosing incident fractures Fig. 3 28 68 . From the spine surgeon s perspective the assessment of an osteoporotic fracture includes consideration of the following criteria Fig. 4 acute and subacute single level fractures fractures with persistent instability multiple fractures with progressive creeping vertebral collapse and loss of sagittal balance and posture vertebral fractures with subsequent spinal stenosis neural compression From a surgical perspective the differentiation of acute and old fractures is most important 930 Section Fractures Figure 3. Morphometric criteria Typical morphometric criteria for diagnosing incident fractures Melton 68