Major Surgical Treatment of Osteoporotic Vertebral Fractures in the Elderly: A Comparison of Anterior Spinal Fusion, Anterior-Posterior Combined Surgery and Posterior Closing Wedge Osteotomy

STUDY DESIGN: A retrospective study. PURPOSE: To clarify the differences among the three major surgeries for osteoporotic vertebral fractures based on the clinical and radiological results. OVERVIEW OF LITERATURE: Minimally invasive surgery like balloon kyphoplasty has been used to treat osteoporotic vertebral fractures, but major surgery is necessary for severely impaired patients. However, there are controversies on the surgical procedures. METHODS: The clinical and radiographic results of patients who underwent major surgery for osteoporotic vertebral fracture were retrospectively compared, among anterior spinal fusion (group A, 9 patients), single-stage combined anterior-posterior procedure (group AP, 8 patients) and posterior closing wedge osteotomy (group P, 9 patients). Patients who underwent revision surgery were evaluated just before the revision surgery, and the other patients were evaluated at the final follow-up examination, which was defined as the end point of the evaluations for the comparison. RESULTS: The operation time was significantly longer in group AP than in the other two groups. The postoperative correction of kyphosis was significantly greater in group P than in group A. Although the differences were not significant, better outcomes were obtained in group P in: back pain relief at the end point; ambulatory ability at the end point; and average loss of correction. CONCLUSIONS: The posterior closing wedge osteotomy demonstrated better surgical results than the anterior spinal fusion procedure and the single-stage combined anterior-posterior procedure.

Repeated Vertebral Body Fracture at Different Levels due to Sagittal Imbalance

The authors report a case of repeated vertebral body fracture at different levels due to sagittal imbalance resulting from long level spinal fusion after thoracic discectomy. A 69-year-old woman with severe cord compression at T9-T10-T11 due to calcified herniated discs underwent an anterior thoracotomy via the left transpleural approach followed by discectomy of T9-T10-T11. Six weeks later, she complained of severe thoracic and right flank pain after falling over. A newly developed burst fracture resulting in sagittal imbalance was detected, so the authors performed posterior fusion from T8 to L2 and pedicle screw fixation. Unfortunately, 4 months after the second ope- ration the patient revisited our hospital complaining of severe back and right leg pain. The whole spine lateral view revealed a newly developed bursting fracture of L3 and more aggravated sagittal imbalance accompanied with junctional kyphosis at the L2-L3 level. The authors performed a third operation composed of anterior lumbar inter- body fusion at the L5-S1 level and L3 closing wedge osteotomy with fixation for better sagittal balance and nerve decompression. The patient showed no evidence of postoperative neurological compromise. Her back and leg pain improved over time, and she was completely pain-free at 4 months after the surgery

Percutaneous Vertebroplasty: Considerations for the Safe Procedures / 신경중재치료의학

Percutaneous vertebroplasty, injection of bone cement into the vertebral body, is a very effective interventional technique to improve the pain intractable to the conservative treatment and to achieve the structural augmentation for the vertebral body fractures. The procedure has been widely performed to manage osteoporotic and other vertebral fractures because the technique is known as simple and low-risk. This review is about the several aspects of the percutaneous vertebroplasty for the sake of safe and effective procedure.

Surgical Treatment for Lumbar Spinal Stenosis with Fracture in Multiple Osteoporotic Compression Fractures / 대한척추외과학회지

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the outcome of the surgical treatment for lumbar spinal stenosis with fracture in multiple osteoporotic vertebral body compression fractures. SUMMARY OF LITERATURE REVIEW: An osteoporotic vertebral compression fracture, without neurological symptom, has mainly been treated with conservative care. Sometimes, vertebroplasty or kyphoplasty has been used as a surgical treatment. In the case of a single thoracolumbar fracture with neurological symptoms, not improved by conservative care, decompression, fusion and instrumentation through an anterior or a posterior approach has been attempted. MATERIALS AND METHODS: 10 patients, who had received surgical treatment for symptomatic lumbar spinal stenosis with fracture out of those with multiple osteoporotic vertebral body compression fractures, and over the age of 60, were assessed. The surgical treatment was performed on the patient with all of the following five criteria; (1) severe back pain caused by fractures, (2) neurological symptoms of lumbar spinal stenosis, (3) radiological evidences of stenosis by lumbar fracture, (4) no response to conservative treatment for over 3 months, and (5) adequate physical ability for daily living without a severe medical condition. The surgical procedure included: decompressive laminectomy, posterior instrumentation using pedicle screw fixation, and fusion in situ. The pedicle screws were located 2-3 above and below the most cephalad and caudad fractured vertebral bodies. RESULTS: Clinically, favorable results were obtained in 8 of the 10 patients. In the roentgenographic assessment, the operated states were well maintained, without the metallic failure or instability. Halos around the pedicle screws were seen in 4 patients, but there was no significant evidence of loosening. There were no serious medical and systemic complications in the peri- and postoperative periods. Additional vertebral body fractures and pain were seen in 5 patients, but they had been well managed, conservatively. CONCLUSION: Favorable clinical results could be expected for the surgical treatment of lumbar spinal stenosis, with fracture, in the patients with multiple osteoporotic vertebral fractures, as long as the surgical treatment was indicated exactly and carefully.

An Analysis of Cranio-spinal Fracture in Case of Free-falling Trauma

It is known that free-falling accident is one of the major causes of head or spinal injury, especially in the elderly and children. But, the frequent injury types are diverse according to the reports because of the different subjects studied among the reports. A cranio-spinal injury caused by free-falling accident from height hasn't been studied a lot in Korea yet. To evaluate the clinical aspects of cranio-spinal fracture caused by free-falling injury which developed particularly in a certain fixed place, we analyzed 122 patients who had had the fractures involving extremities, ribs, and cranio-spinal regions during the past 4 years from January 1994 through July 1997. Forty-seven patient(38.5%) had the cranio-spinal fracture. The incidence of the skull and vertebral body fracture were significantly higher than that of the vertebral transverse process fracture, respectively (p=.052 and p=.007). There was statistically insignificant in the height of falls between the skull and vertebral body fracture(p=.175). Associated extra- craniospinal fractures were noted on radius(25.4%), rib(20.5%), femur(9%), calcaneus(5.7%), and pelvic bone(4.9%), in order of frequency.