James Yue M.D.
Associate Professor of Orthopaedic Surgery
Director of the Spinal Institute, Yale University

Discussion & Issues Affecting the Spine as we Age

Question: What are the major issues that affect the spine as we age?

Answer: The major issues which affect the aging spine include: osteoporosis, spinal stenosis, facet degeneration, degenerative scoliosis and degenerative disc disease.

Question: Why is it important to be informed about the aging spine and its effect on the body?

Answer: In my opinion, the most important aspect of the aging spine, in terms of the direct impact on patients’ lives, is how to address vertebral compression fractures. The National Osteoporosis Foundation (NOF) estimates that roughly 700,000 people will suffer from vertebral compression fractures each year, in the US alone. Vertebral compression fractures have a direct impact on the quality of patients’ lives and can sometimes even effect the duration of their lives.

Question: What are vertebral compression fractures (VCFs)?

Answer: Vertebral compression fractures occur as a result of a loss of bone density or osteoporosis. A decrease in the overall amount of bone tissue causes a structural weakening of the bone. Menopause, the use of steroids, smoking, a lack of exercise, and a diet poor in calcium and Vitamin D are leading causes of osteoporosis. It has been determined that osteoporosis has a direct effect on the incidence of vertebral compression fractures. A patient with poor bone density is at higher risk for developing a vertebral compression fracture, and the pain and disability associated with such fractures.

Question: Are vertebral compression fractures mainly a concern for women, or can they occur in men as well?

Answer: While a majority of fractures that occur as a result of osteoporosis occur in women, anyone can experience a vertebral compression fracture. We are all living longer and we as healthcare providers, are seeing a lot more of both male and female patients experiencing vertebral compression fractures.

Question: What can people do to minimize their risk of vertebral compression fractures?

Answer: Eating a proper diet with calcium and Vitamin D, regular walking, abstaining from smoking, nutritional supplementation, hormone therapy, and bone density evaluations.

Question: What options are available to patients once they have experienced a fracture of the vertebrae?

Answer: There are many options that patients can discuss with their physician, conservative measures include: a short period of bedrest and then mobilization in a spinal brace. Surgical alternatives include reinforcing the spinal fracture with a cement-like material with or without an internal stent-like device such as the OsseoFix*.

Question: If a patient were to present in your office today with a vertebral compression fracture how would you treat it.

Answer: If you were to ask me how I would treat it today, versus how I would treat the fracture in, what I hope to be the very near future, you would get two very different answers. Today I would treat the patient utilizing a procedure called a vertebroplasty or kyphoplasty. This is where cement is injected into the vertebral body to help stop the vertebrae from collapsing in even more.

However, I have been very fortunate to travel overseas to Europe and witness the successful implantation of a product that is cutting edge and can greatly enhance the vertebroplasty procedure. This system is called the OsseoFix spinal fracture reduction system. It is available in many parts of Europe and it is my hope that surgeons in the US will soon have this technology available to us.

What Osseofix does that is different than a vertebroplasty is that it helps to restore the height of the vertebrae before the cement is injected. This is beneficial because it makes the procedure safer and more controlled. In addition, unlike other systems I have seen on the market the Osseofix uses a small titanium stent which goes into the vertebrae and maintains the height of the vertebrae. I like it because it is consistent and reproducible. As a surgeon, I don’t like surprises in the OR, I like to know that products will work the same each time I use it. Other systems that just use cement, or balloons don’t give me confidence that the technique is reproducible time after time, surgery after surgery.

Question: Can you describe how the OsseoFix will be used?

Answer: Yes the OsseoFix can be used to treat patients with acute fractures or in some instances delayed fractures of the vertebrae. Keep in mind that many fractures will heal by themselves with bracing, without surgery. However, approximately 25-30% of patients that experience a vertebral compression fracture will most likely benefit from this type of procedure.

Question: In your opinion, how will the availability of the OsseoFix be good for surgeons and their patients?

Answer: The OsseoFix device has been designed to be more anatomically friendly to the vererbral body during surgical application and insertion. It has also been designed to be placed percutaneously in a minimally invasive fashion. Thereby, allowing the physician to deploy this device with the patient using only a local anesthetic, if this is indicated. The safety margin in this particular procedure is higher, we think, as compared to previous surgical procedures, which in turn would make the surgical procedure safer for the patient and faster recovery.

Thank you Dr. Yue, are there any closing comments that you would like to make.

Dr. Yue: Yes, Today I shared with you just a little bit about a technology that I recently learned of, but I would stress to patients, that there is a lot of information out there today, new and ever changing technologies, partner with your physician for your healthcare.


*The OsseFix has not been cleared for use in the United States and is not available for sale in the United States.