A Management for Osteoporotic Bursting Fractures of the Thoracic and Lumbar Spines in the Aged: Posterior Approach with Intraoperative Vertebroplasty

ABSTRACT

OBJECTIVE: Treatments of osteoporotic bursting vertebral body fracture(OBF) of thoracic and lumbar spines have been limited to conservative managements especially in the elderly patients. The authors correct kyphosis and stabilize the spine by the posterior approach with intraoperative polymethylmethacrylate(PMMA) vertebroplasty. METHODS: From March 1999 to June 2000, eight patients with OBF underwent posterior approach with intraoperative vertebroplasty. The patients included 7 women and 1 man aged 54-82 year. Average T-score on bone marrow density was -3.02. In the case of old fracture with sclerosis in the posterior wall, after laminectomy, the retropulsed posterior wall of the fractured spine was reduced with L-shaped micro-bone impactor through the lateral epidural spaces, in prone position. About 6cc of PMMA was injected into the fractured vertebral body via transpedicular route, and then, small amount of PMMA was also injected into each entry point of the screws. All patients underwent one above and one below short segment fixation followed by correction of kyphotic deformity. RESULTS: The preoperative clinical symptoms improved gradually in all patients. During postoperative follow-up for more than 7 months, there was no recurrence of the preoperative clinical symptoms, aggravation of kyphosis or instrumentation failure. CONCLUSIONS: It is suggested that posterior approach with short segment fixation and intraoperative PMMA vertebroplasty could be a new surgical modality for osteoporotic bursting fracture of the thoracic and lumbar spines especially in the aged.