J Korean Soc Spine Surg.  2005 Mar;12(1):75-82. 10.4184/jkss.2005.12.1.75.

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

• Rhyu KW
• Lee HY
• Song JH
• Koh HS
• Kang YK
• Jeong JY
• Lee JY
• Kim BK

• KMID: 1897025
• DOI: http://doi.org/10.4184/jkss.2005.12.1.75

Abstract

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.

Keyword

Osteoporotic vertebral body fracture; Lumbar spinal stenosis; Posterior decompression and fusion

MeSH Terms

Back Pain
Constriction, Pathologic
Decompression
Fractures, Compression*
Humans
Kyphoplasty
Laminectomy
Postoperative Period
Retrospective Studies
Spinal Stenosis*
Vertebroplasty

Figure

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  Fig. 1. The plain roentgenography of 73-year old female patient. The AP (A) and lateral (B) films show type 2, biconcave fracture of L2 vertebral body and slight height loss of L3 vertebral body.

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  Fig. 2. The sagittal T2-weighted MRI (A) shows biconcave fractures at L2 and L3 vertebrae. The spinal canal is narrowed at L2-3, L3-4, and L4.5 interlaminar spaces. The axial T2-weighted MRI of L2-3 (B) and L3-4 (C) show central and lateral recess stenosis.

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  Fig. 3. The operation is done with L2-5 decompressive total laminectomy, posterior instrumentation, and fusion. There was no complication during peri- and postoperative period. She started ambulation with TLSO brace since 1 week after surgery. A) is AP and B) is lateral roentgenographic film.

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  Fig. 4. At 30 months postoperatively, the operated site is maintained well. It is not easy to define the degree of bony fusion. But, there are no definite evidence of nonunion or implant failure. The clinical outcome of this patient is good and she just takes the medication for osteoporosis. A) is AP and B) is lateral roentgenographic film.

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