Spinal fractures due to bone weakness in elderly individuals can occur even with minor trauma. In this article, we discuss the treatment options and the decision-making process.
Non-Surgical Monitoring? Minimally Invasive Cement Injection? Screw-Based Stabilization?
Spinal fractures in elderly individuals have become a significant health concern both clinically and socially. Especially with age-related loss of bone density (osteoporosis), these fractures can occur even with minor trauma—or sometimes in the absence of any trauma at all.
Why Are Spinal Fractures More Common in the Elderly?
With advancing age, both bone density and muscle mass decrease, making spinal structures more fragile.
- Minor falls at home
- Sudden movements such as standing up or sitting down
- Even simple actions like coughing can lead to compression fractures in the vertebral bodies.
What Are the Treatment Options?
The treatment of spinal fractures in elderly patients should be planned by taking into account the patient’s overall health status, fracture severity, pain level, bone quality, and accompanying conditions. There are three main approaches:
1. Brace Treatment (Conservative Management)
In patients with mild compression fractures and good general health, brace treatment is usually the first-line option.
However, the following points must be carefully evaluated:
- Can the patient tolerate and comply with brace use?
- Is the fracture progressing despite bracing?
- Are regular standing X-rays being performed weekly?
If pain persists or the collapse progresses despite bracing, surgery should be planned without delay.
2. Vertebroplasty – Kyphoplasty (Minimally Invasive Bone Cement Procedure)
If the fracture is more advanced or the patient cannot tolerate a brace, bone cement procedures (polymethylmethacrylate – PMMA) under local anesthesia become an option.
- Special needles are used to inject bone cement into the fractured vertebra.
- Most patients can be mobilized the same day.
- In patients with high pain levels, limited mobility, or risk of further collapse, early intervention can improve outcomes.
3. Instrumented Stabilization Surgery (Screw Fixation)
If the spinal fracture is severe and complicated by instability or failure of the bones to fuse, cement-based methods may be insufficient.
- In such cases, stabilization using titanium screws may be necessary.
- This procedure can sometimes be performed with minimally invasive techniques, but in more complex cases, larger surgeries with additional cage support may be required.
Key Factors in Treatment Selection
The treatment plan should be based not only on the type of fracture but also on the patient's overall health status. Important considerations include:
- Severity of pain
- Bone quality and level of osteoporosis
- Chronic conditions such as diabetes, hypertension, or heart disease
- Fracture location (thoracic, lumbar, cervical)
- Patient’s mobility potential
→ In some cases, a simple vertebroplasty under local anesthesia may spare the patient from major surgery. However, insisting on conservative treatment in an unsuitable patient can result in progression of the fracture and the need for a more extensive surgical intervention.
Individualized Treatment Is Essential in Elderly Patients
Regardless of which treatment method is chosen, two critical factors must be addressed for successful outcomes in elderly patients:
- Bone Quality: The degree of osteoporosis should be measured, and medical treatment initiated if necessary.
- Identifying the Cause: The underlying cause of the fracture must be determined—treatment should target not only the symptoms but also the etiology.