Posterior Surgery of Neurologically Compromised Osteoporotic Kyphosis: Posterolateral Decompression and Stabilization using Titanium Mesh / 대한정형외과학회잡지

PURPOSE: Several treatment options have been reported for post-traumatic kyphosis (PTK) and neurologically compromised osteoporotic fractures. However, there is no ideal surgical procedure. This study evaluated the effectiveness of posterolateral decompression and anterior support with a titanium mesh in PTK by posterior surgery. MATERIALS AND METHODS: Seventeen patients with PTK and neurologically compromised osteoporotic fractures underwent a single posterior approach. During posterior decompression, a titanium mesh was inserted through the posterior approach after a transpedicular intracorporeal corpectomy. Complications, operating time and blood loss were noted, and radiographic studies and neurological status were evaluated before surgery, after surgery, and at final follow-up. RESULTS: The mean kyphosis was 35+/-9.7degrees (range; 17-58degrees) before surgery, 3.2+/-1.8degrees after surgery (correction; 90.5%) and 5.5+/-3.2degrees at the final follow-up (correction; 85.5%). There was 29.6degrees correction of the kyphosis with a 6% loss of correction. Postoperative neurological improvement using the Frankel classification was demonstrated in all patients. There was no new onset or progressive neurological deterioration, additional surgery or extrusion of mesh. Three complications were encountered: one care each of pneumonia, prolonged ventilator support and distal adjacent vertebral fracture. CONCLUSION: The posterior insertion of a titanium mesh for anterior support appears to maintain the length of the anterior column, stabilize the injured vertebra and facilitate spinal fusion. Posterolateral decompression allows as direct a decompression as the anterior approach.

Fusion of Pedicular Cleft Using Pedicle Screw Fixation: A Case Report / 대한척추외과학회지

There is a broad range of lumbar pedicular and neural arch anomalies, with spina bifida occulta and spondylolysis being especially common. It is very rare for a pedicular cleft to be associated with contralateral spondylolysis in the same vertebral segment. We observed L4 spondylolisthesis, clefting of the left L4 hypertrophied pedicle associated with contralateral spondylolysis, and spinal stenosis on a radiographic study of the lumbar spine. Operative treatment was performed, with posterior decompression, partial removal of the hypertrophied pedicle, posterior lumbar interbody fusion using a cage, and posterior instrumentation. The patient's neurologic symptoms resolved after operative treatment. Fusion of the left pedicle cleft was observed on 6-month follow-up CT. We report one case of pedicular cleft fusion using pedicle screw fixation and present a review of the relevant literature.