Anterior Decompression and Fusion with Instrumentation in Osteoporotic Vertebral Fracture

Kee-Yong Ha; Seung-Joon Ryoo; Hyung-Moon Yoon

doi:10.4184/jkss.2003.10.4.311

Journal List > J Korean Soc Spine Surg > v.10(4) > 1035595

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Ha, Ryoo, and Yoon: Anterior Decompression and Fusion with Instrumentation in Osteoporotic Vertebral Fracture

Original Article

Journal of Korean Spine Surg 2003;10(4):311-320.

Published online: 21 February 2003

DOI: https://doi.org/10.4184/jkss.2003.10.4.311

Anterior Decompression and Fusion with Instrumentation in Osteoporotic Vertebral Fracture

Kee-Yong Ha, M.D., Seung-Joon Ryoo, M.D., Hyung-Moon Yoon, M.D.

Department of Orthopaedic Surgery, Kang-Nam St. Mary's Hospital The Catholic University of Korea, College of Medicine

Address reprint requests to Kee-Yong Ha, M.D. Department of Orthopaedic Surgery, Catholic University of Korea, Gang-nam St. Mary's Hospital #505 Banpo-dong, Seocho-gu, Seoul, 137-701, Korea Tel: 82-2-590-1464, Fax: 82-2-535-9834, E-mail: kyh@cmc.cuk.ac.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A Retrospective study

Objective

To evaluate the results after an anterior decompression and fusion, with anterior instrumentation, using a Z- plate in osteoporotic vertebral fractures.

Summary of Literature review

Despite conservative treatment, continuous severe pain, progressive neurological impairments and deformity may need surgical treatment in osteoporotic vertebral fractures accompanied with neurological deficit.

Materials and Methods

Fourteen patients that had undergone anterior decompression and an autogenous iliac bone graft, with anterior internal fixation, between 1997 and 2001, under the diagnosis of an osteoporotic vertebral fracture, were reviewed. The chief complaints, severity of pain measured, using the Denis pain scale, fracture patterns, fracture level, changes of kyphotic angle (revised with sagittal index) and complications were analyzed.

Results

Symptoms subsided completely in 5 patients, one case showed no definite improvement and 8 showed improved symptoms. The fracture levels included: 1 and 2 cases at the 11th and 12th thoracic spine, and 8, 1 and 2 in the 1st, 2nd and 3rd lumbar spine, respectively. 10 patients showed wedge type fractures, three a compression type and one a biconcave type. The average kyphotic deformity decreased 49.0% (50.9% when revised with sagittal index) after surgery, but the average loss of correction angle was 28.8% (26.0% when revised with sagittal index), compared with the immediate postoperative correction angle.

The complications included

screw loosening and adjacent vertebral fractures in 3 and 4 patients, respectively. Two patients had the combined problem of screw loosening and an adjacent vertebral fracture.

Conclusion

In anterior decompression and fusion, with instrumentation, for osteoporotic vertebral fracture treatment, the complications were primarily related, directly or indirectly, to the underlying osteoporosis. Complete neurological recovery occurred 9 of the 11 patients, but residual pain was common.

Keywords: Thoracolumbar, Osteoporosis, Vertebral fracture, Kyphotic angle, A nterior fusion

REFERENCES

1). Ha KY, Kim KW, Park SJ, Paek DH, Ha JH. The surgical treatment of osteoporotic vertebral collapse caused by minor trauma. J Kor Orthop Assoc. 1998; 33:105–111.

2). Mochida J, Toh E, Chiba M, Nishimura K. Treatment of osteoporotic late collapse of a vertebral body of thoracic and lumbar spine. J Spinal Disord. 2001; 14:393–398.

3). Eastell R, Cedel SL, Wahner HW, Riggs BL, Milton LJ I II. Classification of vertebral fractures. J Bone Miner Res. 1991; 6:207–215.

4). Denis F. Spinel stability as defined by the three-column spine concepts in acute spinal trauma. Clin Orthop. 1984; 189:65–76.

5). Frankel HL, Hancock DO, Hyslop G. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Part I. Paraplegia. 1969; 7:179–192.

6). Farcy JPC, Weidenbaum M. Sagittal index in management of thoracolumbar burst fracture. Spine. 1990; 15:958–965.

7). Lee YL, Yip KM. The osteoporotic spine. Clin Orthop. 1996; 323:91–97.

8). Soshi S, Shiba R, Kondo H, Murota K. An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar spine. Spine. 1991; 16:1335–1341.

9). Kaneda KS, Ascano S, Hashimoto T, Satoh S, Fjiya M. The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis. Spine. 1992; 17:S295–303.

10). Kirkpatrick JS, Wilber RG, Likavec M, Emery SE. Anterior stabilization of thoracolumbar burst fractures using the Kaneda device: a preliminary report. Orthopae-dis. 1995; 18:673–678.

11). Hoan- VN, Steven L, Daniel G. Osteoporotic Vertebral Burst fractures with Neurologic Compromise. J Spinal Disord. 2003; 16:10–19.

12). Suk SI, Kim JH, Lee SM, Chung ER. Anterior-posterior surgery versus posterior closing wedge osteotomy in post - traumatic kyphosis with neurologic compromised osteo -.

Figures and Tables%

Fig. 1.

Classification of osteoporotic vertebral fractures by type (A) Wedge deformity, (B) Biconcavity deformity, (C) Compression deformity

Fig. 2.

Change of average degrees of kyphotic deformity (revised with sagittal index)

Fig. 3.

Change of average t-value (BMD)

Fig. 4.

Comparison of t-value of osteoporosis complication and non-complication case: there is no statistical significance (p > 0.05) (Mean: average t-value of whole cases No Cx: average t-value of cases without complications AV Fx: average t-value of cases which show adjacent vertebral fracture SL: average t-value of cases which show screw loosening)

Fig. 5.

showing screw loosening (white arrow)

Fig. 6.

showing both screw loosening and fracture at adjacent vertebrae

Table 1.

Summary of 14 Cases

Case. No	Delay in op	Location	Fx type	Pain		Neurologic Deficit		Kyphotic deformity (degrees)			Preop BMD (t-value)			Postop BMD (t-value)
Case. No	Delay in op	Location	Fx type	Preop	Last F/U	Preop	Last F/U	Preop	Postop	Last F/U	Spine AP	Spine Lat	Femur AP	Spine AP	Spine Lat	Femur AP
1	9 mo	LI	W2	P5	P4	R/P	no	30	8	10	-2.9	-3.37	-3.7	-2.4	-3.4	-4.1
2	3 mo	D12	CI	P4	P2	D1	D2	12	6	9	-3.3	-3.5	-3	-2.9	-2.9	-3.2
3	3 days	LI	W2	P4	PI	R/P	no	33	20	25	-2.8	-3.6	-3	-3.1	-2.7	-3.8
4	2 weeks	L3	BC2	P5	P4	R/P	no	12	3	5	-3.5	-3.7	-3.3	-3	-3.5	-3.5
5	5 mo	L3	W2	P5	P4	R/P	no	37	15	20	-3	-3.2	-3	-3	-2.4	-1.7
6	1 weeks	D12	W2	P4	P3	no	no	30	20	25	-3.4	-3.4	-3.3	-3.2	-3.2	-2.7
7	2 mo	LI	CI	P4	P3	R/P	no	11	5	5	-3.3	-3.1	-3.1	-3.1	-3.2	-3.3
8	1 weeks	LI	W2	P4	PI	R/P	no	25	14	14	-3.4	-3.4	-2.9	-2.7	-2.8	-3.2
9	1 mo	LI	W2	P4	PI	С	D1	45	43	40	-3.4	-3.5	-3	-2.6	-3.1	-3.1
10	2 mo	L2	W2	P4	PI	R/P	no	39	21	31	-3.3	-3.1	-3.2	-2.8	-3.1	-3.3
11	20 days	Dil	W2	P4	P3	no	no	28	12	15	-3.2	-3.4	-2.9	-2.8	-2.5	-3
12	1 day	LI	W2	P4	P3	R/P	no	32	20	28	-3.2	-3.4	-2.6	-2.7	-3	-3.5
13	1 day	LI	W1	P4	PI	R/P	no	10	5	13	-3	-2.8	-3.2	-2.6	-3.2	-2.4
14	3 mo	LI	W1	P4	P4	R/P	no	18	5	5	-3	-2.7	-2.9	-3.3	-3	-3.6
Mean								25.9	14.1	17.5	-3.19	-3.32	-3.08	-2.87	-3	-3.17

Table 2.

Modified Frankel Grade

Grade	Motor Function	Function of bladder & bowel
A	0	paralysis
B	0-1	paralysis
C	2	paralysis or dysfunction
D1	3	paralysis to normal
D1	4-5	paralysis
D2	4-5	dysfunction
D3	4-5	normal
E	5	normal

Table 3.

Assessment of the clinical symptom according to five-grade Denis pain scale. (Denis Pain Scale)

Scal	Symptoms
P1	no pain
P2	slight pain with no need for medication.
P3	moderate pain with a need for occasional medication
P4	moderate to severe pain with a need for frequent medication and occasional absence from work or a major change in activities of daily living
P5	constant or severe incapacitating pain and a chronic need for medication

TOOLS

Similar articles