J Korean Soc Spine Surg.  2003 Jun;10(2):172-179. 10.4184/jkss.2003.10.2.172.

Treatment of Osteoporotic Vertebral Collapses of the Thoracolumbar Spine with Neurologic Deficits using Anterior Approach

• Lee SH
• Kim YB
• Lee ST
• Kim TS
• Oh KJ
• Na JI

• KMID: 2003215
• DOI: http://doi.org/10.4184/jkss.2003.10.2.172

Abstract

STUDY DESIGN: Retrospective
OBJECTIVES
To evaluate the clinical and radiological results of treatment for thoracolumbar spine fractures, with neurological deficits, using an anterior approach in a senile osteoporotic spine. SUMMARY OF BACKGROUND DATA: With osteoporotic vertebral collapses, an operative treatment may be indicated for lesions that are considered unstable, especially if there is spinal canal compromise with neurological deficits. As for the treatment of these cases, a posterior approach destabilizes, and increases, the kyphotic deformity, resulting in the need for a longer fusion period. A combined anterior-posterior approach increases the morbidity. A one stage anterior decompression and anterior reconstructive stabilization is often the most reasonable operative choice.
MATERIALS AND METHODS
Between January 1999 and August 2001, 12 cases of thoracolumbar osteoporotic vertebral collapse, with neurological deficits, were performed. There were 10 female and 2 male cases. The mean age for the patient was 69.3 years, ranging from 60 to 79 years. The numbers of each level of fractured vertebrae were; 2, 5, 4 and 1, in eleventh thoracic, twelfth thoracic, first lumbar and second lumbar vertebrae, respectively. All patients reported minor injury or trauma, and the average interval between injury and operation was 8.3 months, ranging from 1 to 36 months. There were 4 and 8 cases of neurological deficits in the Frankel D2 and D3 groups, respectively. The average preoperative local kyphotic angle was 23.8 degrees, ranging from 5 to 35 degrees, with a 66% loss in height, ranging from 42 to 83%). The average T score from the Bone Densitometry was -3.7 S.D, ranging from -3.2 to -4.4. The operations were performed by an extrapleural-retroperitoneal approach. The anterior instrumentation was performed with the Kaneda system and a titanium mesh cage. All cases were followed for more than 12 months.
RESULTS
All cases had a solid bony fusion. The immediate postoperative average local kyphotic angle was 10.3 degrees, ranging from -14 to 22 degrees, and the correction loss at the last follow-up was 2.6 degrees, ranging from 0 to 9 degrees. All 12 patients with incomplete preoperative neurological deficits improved, postoperatively, to Frankel group E.
CONCLUSIONS
The one stage anterior spinal decompression and reconstruction, with a Kaneda instrument and a titanium mesh cage, afforded enough stability in patient with an osteoporotic vertebral collapse to enable early ambulation and to achieve realignment and solid fusion, and seems to have merit in the neurological recovery following an operation.

Keyword

Thoracolumbar spine; Osteoporosis; Neurologic deficits; Fracture treatment; Anterior approach

MeSH Terms

Congenital Abnormalities
Decompression
Densitometry
Early Ambulation
Female
Follow-Up Studies
Humans
Lumbar Vertebrae
Male
Neurologic Manifestations*
Osteoporosis
Retrospective Studies
Spinal Canal
Spine*
Titanium
Titanium

Figure

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  Fig. 1. Preoperative lateral view shows first lumbar vertebtal fracture with kyphotic deformity of 35° angulation.

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  Fig. 2. MRI mid-sagittal view shows retropulsed bony fragment into spinal canal.

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  Fig. 3-A, B. Radiographs at 17 months after operation demonstrates good union with correction of deformity.

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  Fig. 4-A, B. MRI mid-sagittal and axial views at 17 months after operation demonstrate complete decompression of spinal canal.

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