Résumé
STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the clinical and radiological results of anterior decompression and instrumentation for delayed vertebral body collapse in neurologically compromised osteoporotic compression fractures. LITERATURE REVIEW SUMMARY: Indications for an operation in delayed vertebral body collapse, following osteoporotic compression fractures, are intractable pain, progressive kyphosis and neurological deficits. The options for an operation are anterior, posterior and combined anterior and posterior approaches. Posterior surgery may need some degree of destruction of intact posterior elements. Combined anterior and posterior surgery increases the morbidity and mortality due to increased operative time and blood loss. Therefore, a one stage anterior surgery is a reasonable choice. MATERIALS AND METHODS: Between June 1989 and May 2003, seven cases of delayed vertebral body collapse, with neurological deficit, were treated using anterior decompression and anterior Kaneda instrumentation. All the cases were female, with a mean age of 67, ranging from 57 to 77 years. The average follow up period was 3.4, ranging from 1 to 13 years. One patient had a history of steroid medication. The operation time, intraoperative blood loss and bone mineral density were retrospectively reviewed. The changes in the kyphotic angle, preoperatively, postoperatively and on the last follow-up plain lateral radiograph were measured. The clinical results were evaluated based on a modified Frankel grading and visual analogue scale RESULTS: The average kyphotic angles preoperatively, postoperatively and at the last follow up were 29 degrees(25~47 degrees), 14 degrees(6~20 degrees) and 19 degrees(10~27 degrees), respectively. In all cases, the preoperative neurological deficits were improved by more than one degree in the Frankel grading at the final follow up. The mean operation time, blood loss and mean bone mineral density were 3.2 hours, 1514ml and T: -3.51, respectively. The values from the visual analogue scale preoperatively and at the last follow up were 7.0 and 0.5, respectively. CONCLUSIONS: Anterior decompression and instrumentation provides effective neurological decompression and stabilization of the spine by supporting the deficient anterior column in delayed vertebral body collapse.
Sujets)
Femelle , Humains , Densité osseuse , Décompression , Études de suivi , Fractures par compression , Cyphose , Mortalité , Durée opératoire , Douleur rebelle , Études rétrospectives , RachisRésumé
STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the clinical and radiological results of anterior decompression and instrumentation for delayed vertebral body collapse in neurologically compromised osteoporotic compression fractures. LITERATURE REVIEW SUMMARY: Indications for an operation in delayed vertebral body collapse, following osteoporotic compression fractures, are intractable pain, progressive kyphosis and neurological deficits. The options for an operation are anterior, posterior and combined anterior and posterior approaches. Posterior surgery may need some degree of destruction of intact posterior elements. Combined anterior and posterior surgery increases the morbidity and mortality due to increased operative time and blood loss. Therefore, a one stage anterior surgery is a reasonable choice. MATERIALS AND METHODS: Between June 1989 and May 2003, seven cases of delayed vertebral body collapse, with neurological deficit, were treated using anterior decompression and anterior Kaneda instrumentation. All the cases were female, with a mean age of 67, ranging from 57 to 77 years. The average follow up period was 3.4, ranging from 1 to 13 years. One patient had a history of steroid medication. The operation time, intraoperative blood loss and bone mineral density were retrospectively reviewed. The changes in the kyphotic angle, preoperatively, postoperatively and on the last follow-up plain lateral radiograph were measured. The clinical results were evaluated based on a modified Frankel grading and visual analogue scale RESULTS: The average kyphotic angles preoperatively, postoperatively and at the last follow up were 29 degrees(25~47 degrees), 14 degrees(6~20 degrees) and 19 degrees(10~27 degrees), respectively. In all cases, the preoperative neurological deficits were improved by more than one degree in the Frankel grading at the final follow up. The mean operation time, blood loss and mean bone mineral density were 3.2 hours, 1514ml and T: -3.51, respectively. The values from the visual analogue scale preoperatively and at the last follow up were 7.0 and 0.5, respectively. CONCLUSIONS: Anterior decompression and instrumentation provides effective neurological decompression and stabilization of the spine by supporting the deficient anterior column in delayed vertebral body collapse.