Fractura vertebral osteoporótica en el adulto mayor / Osteoporotic vertebral fracture in the elderly

La fractura osteoporótica es una entidad clínica que afecta seriamente la calidad y expectativa de vida del paciente, agregándose un impacto socioeconómico elevado, superando incluso a los gastos de patologías como el infarto agudo de miocardio, accidente cerebrovascular y cáncer de mama, y cuya incidencia y prevalencia va en aumento a medida que la población mundial envejece. La gran mayoría de los casos cursan inadvertidos y sub diagnosticados, dejando a tres de cuatro pacientes, sin tratamiento y expuestos a nuevos eventos. El foco mundial en los países desarrollados como estrategia de enfrentamiento de esta patología endémica ha sido el de la prevención, vale decir medicina primaria. Sin embargo, una vez diagnosticada la fractura osteoporótica, no existe consenso en el tipo de tratamiento óptimo, así como sus plazos en estos pacientes. La mayoría de las guías internacionales y los trabajos publicados, presentan diferencias en el manejo de esta lesión.

The osteoporotic fracture is a clinical entity that seriously affects the quality and life expectancy of the patient, adding a high socioeconomic impact, even exceeding the expenses of pathologies such as acute myocardial stroke, vascular cerebral stroke and breast cancer, and whose incidence and prevalence is increasing as the world population ages. The vast majority of cases are non-diagnosed, leaving three of four patients with non treatment at all. The target in developed countries as a strategy to confront this endemic pathology has been prevention, or, primary medicine. However, once the osteoporotic fracture is diagnosed, there is no consensus on the type of optimal treatment, as well as its deadlines in these patients. The majority of international guidelines and published articles show differences in the management and treatment of this fracture.

Clinical and imaging findings in patients with aggressive spinal hemangioma requiring surgical treatment.

Vertebral hemangiomas (VHs) are frequently asymptomatic lesions found incidentally during investigations for other spinal problems. Symptomatic VHs are less common, and there are few reports of compressive VHs in the literature. VHs with aggressive behavior present with low signal intensity on T1-weighted and high signal intensity on T2-weighted MRI. We present a case series of four patients with compressive VH, all of whom were neurologically compromised. Each of the four patients underwent preoperative arterial embolization followed by surgical treatment of their VHs. All patients recovered normal motor function after surgery. At follow-up (average 53 months), one patient had a recurrent tumor requiring reoperation and radiotherapy. Although it is rare, aggressive VH can be a devastating condition. Total surgical resection or subtotal resection with radiotherapy may be warranted.