Advancement in Fixation Techniques for Osteoporotic Bone: A Narrative Review

Abstract

Osteoporosis, characterized by reduced bone mineral density and compromised bone microstructure, significantly increases the risk of low-impact fragility fractures, particularly in the spine. As the global population ages, the incidence of osteoporotic spine fractures is on the rise. While pedicle screw (PS) instrumentation has become the standard for spinal fusion surgeries, the fragility of osteoporotic bones poses substantial challenges in maintaining spinal alignment and correction. Patients with osteoporosis face a markedly higher risk of complications from spinal instrumentation. The search for an optimal fixation technique like modifications in screw fixation strategies (bicortical purchase, cortical screw trajectories, and double screws augmentation with laminar wires) or cement augmented screws (vertebroplasty augmented screws/fenestrated screws) or modified screw designs (hydroxyapatite-coated screws, expandable screws/fenestrated screws/dual thread screws), for osteoporotic spines is complex, influenced by factors such as bone fragility, altered physiology in the elderly, comorbidities, cognitive impairments, polypharmacy, and pre-existing spinal conditions. This narrative review aims to explore the advancements in spinal fixation techniques for osteoporotic bones, examining their underlying principles, benefits, and limitations, and identifying the gaps that remain in optimizing fixation methods for osteoporotic spines.

Keywords

• cement augmentation
• fixation techniques
• osteoporosis
• vertebral fractures