Delayed Vertebral Collapse in Osteoporotic Vertebral Compression Fractures: Risk Factors and Treatment Strategies

Jung-Hee Lee; Sung Joon Shin; Won-Ju Shin

doi:10.4184/jkss.2017.24.2.137

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Lee, Shin, and Shin: Delayed Vertebral Collapse in Osteoporotic Vertebral Compression Fractures: Risk Factors and Treatment Strategies

Review Article

Journal of Korean Spine Surg 2017;24(2):137-145.

Published online: 30 June 2017

DOI: https://doi.org/10.4184/jkss.2017.24.2.137

Delayed Vertebral Collapse in Osteoporotic Vertebral Compression Fractures: Risk Factors and Treatment Strategies

Jung-Hee Lee, M.D., Sung Joon Shin, M.D., Won-Ju Shin, M.D.

Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, Seoul, Korea

Corresponding author: Sung Joon Shin, M.D. ORCID ID: 0000-0002-1173-9076 Department of Orthopedic Surgery, Graduate School, College of Medicine, Kyung Hee University, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Korea TEL: +82-2-958-8357, FAX: +82-2-964-3865 E-mail: superdave@hanmail.net

Received 14 November 20167 March 2017 Accepted 10 May 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Literature review.

Objectives

To review the complications of osteoporotic vertebral compression fractures (OCFs) with regard to risk factors and treatment strategies.

Summary of Literature Review

Understanding the complications and treatment methods of OCFs is important given their increasing prevalence.

Materials and Methods

Review of the literature.

Results

The complications of OCFs include kyphotic deformity due to a delayed collapse of the vertebral body and neurologic deficits. The pathophysiologic mechanism of these complications has not been established; however, the most accepted theory is posttraumatic avascular necrosis of the vertebral body. The risk factors for these complications include fracture at the thoracolumbar junction, systemic usage of steroids, severe osteoporosis, and radiological intravertebral vacuum cleft. Most of these complications require surgical treatment, the indications for which include progressing axial back pain, pseudarthrosis, kyphotic deformity, and neurologic deficits. Surgical approaches for treating the complications of OCFs include anterior, posterior, and combined anterior-posterior approaches. Osteotomies should be done when deformity correction is needed. The decision among these various surgical methods should be made considering patient factors and the surgeon's ability to achieve the best outcomes with solid fusion.

Conclusions

The complications of OCFs include kyphotic deformity due to delayed collapse of the vertebral body and neurologic deficits. Most of these complications require surgical treatment, in which achieving solid fusion at the fracture site is the ultimate goal. Patient-related factors and the surgeon's ability should be considered prior to making decisions regarding surgery.

Keywords: Osteoporotic vertebral compression fracture, Complication, Kyphotic deformity, Avascular necrosis, Deformity correction

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Fig. 1.

An 83-year-old female developed recent paraplegia accompanied by aggravated back pain 6 months after undergoing kyphoplasty at L1 for an osteoporotic compression fracture. (A) A lateral radiograph demonstrated kyphosis of 33°. (B) Sagittal view of a CT scan 4 months after kyphoplasty at L1, showing a cavity and trabecular disruption in the inferior aspect of the PMMA. (C) Sagittal view of a CT scan 6 months after kyphoplasty at L1, showing breakage of the injected PMMA. (D) T2-weighted MRI shows dural compression by the posterior vertebral body, as well as intravertebral fluid collection around the PMMA, suggesting avascular necrosis at L1. (E) A postoperative radiograph shows the correction of kyphosis to 4° after posterior vertebral column resection. (F) A whole-spine lateral radiograph taken 4 years postoperatively, demonstrating optimal sagittal balance with a well-maintained surgical site. CT, computed tomography; MRI, magnetic resonance imaging; PMMA, polymethylmethacrylate.

Fig. 2.

A 66-year-old female demonstrated recent paraplegia with gradually worsening back pain after an event of slipping down 5 months previously. (A) A whole-spine lateral radiograph shows a severe kyphotic deformity of 50°. (B) T2-weighted MRI shows dural compression at T12-L1. Surgical correction by Steffee osteotomy was performed. (C) A whole-spine lateral radiograph taken 1 year postoperatively demonstrates improvement of the kyphotic deformity to 8°. (D) A sagittal CT scan taken 6 months postoperatively shows solid fusion at the site where osteotomy was performed. MRI, magnetic resonance imaging; CT, computed tomography.

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