J Korean Soc Spine Surg.  2002 Jun;9(2):148-156.

Surgical Treatment of Post-Traumatic Kyphosis with Neurologic Compromised Osteoporotic Fracture: Comparison between Anterior-Posterior Surgery versus Posterior Egg-Shell Procedure

• Suk SI
• Kim JH
• Chung ER
• Lee SM
• Lee JH
• Kim SS
• Won SW
• Park SC
• Chung RY

Abstract

STUDY DESIGN: Retrospective study.
OBJECTIVES
To compare the surgical results between anterior-posterior surgery and posterior eggshell procedures in post-traumatic kyphosis with neurologic compromised osteoporotic fracture. SUMMARY OF LITERATURE REVIEW: Combined anterior-posterior surgery is usually recommended in cases of kyphotic deformities with neurologic deficit secondary to osteoporosis. However, it is associated with significant morbidity in elderly patients.
MATERIALS AND METHODS
Twenty-six post-traumatic kyphosis with neurologic compromised osteoporotic fracture patients subjected to either anterior-posterior surgery (n=11) or posterior egg-shell procedure (n=15) were analyzed. The average age at the operation was 62.6 years (range: 50-82), male : female ratio was 12 : 14, and the average follow up was 2.9 years (range:2.0-4.9). Preoperative interval from injury to operation was 15.4 months (range: 1-36). Thoracolumbar (T12-L1) fracture was in 20 and lumbar fracture was in 6.
RESULTS
There was no significant difference in age, sex, preoperative and postoperative Frankel grade, and preoperative vertebral collapse between two groups(p<0.05). In anterior-posterior group, the mean operation time was 351 minutes with a mean blood loss of 2892 ml, and preoperative kyphosis of 22 degrees was corrected to 11 degrees at latest follow-up with 7 cases of neurologic improvement. In the eggshell group, the mean operative time was 215 minutes with blood loss of 1930 ml, and preoperative kyphosis of 34 degrees was corrected to 8 degrees at latest follow-up with 11 cases of neurologic improvement. Egg-shell group showed significantly less operation time and blood loss with beter kyphosis correction. In anterior-posterior group, postoperative pneumonia was developed in 2 and superficial infection in 1. Distal screw loosening was detected in 4, 2 in anterior-posterior group and 2 in posterior eggshell group. One of them was treated by revision and others were treated by brace more than 6 months.
CONCLUSIONS
Posterior eggshell procedure showed a better kyphosis correction with significantly less operation time and blood loss. It is a preferable alternative to anterior-posterior surgery in post-traumatic kyphosis with neurologic compromised osteoporotic fracture.

Keyword

Post-traumatic kyphosis; Egg-Shell procedure; Osteoporosis; Neurologic deficit

MeSH Terms

Aged
Braces
Congenital Abnormalities
Female
Follow-Up Studies
Humans
Kyphosis*
Male
Neurologic Manifestations
Operative Time
Osteoporosis
Osteoporotic Fractures*
Pneumonia
Retrospective Studies

Figure

• 

  Fig. 1. 65-year-old female with post-traumatic kyphosis after slip down 1.9years ago. She was treated with L1 anterior decompression and T11-L2 posterior interbody fusion. Fig.A. Preoperative X-ray showed severe compression fracture of L1 vertebral body and local kyphosis of 22°. Preoperative neurologic deficit was Frankel grade D. Fig.B. Preoperative MRI showed neural compression at L1 spinal cord. Fig.C. Postoperative 3 year X-ray showed well maintained state of screws and bone union of graft site. Kyphosis was corrected to 8° with neurologic improvement to Frankel grade E.

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  Fig. 2. 68-year-old male with post-traumatic kyphosis after slip down 4 month ago. He was treated with T12 posterior Egg-Shell decompression and T10-L2 posterior interbody fusion. Fig. A. Preoperative X-ray showed severe compression fracture of T12 vertebral body and local kyphosis of 30°. Preoperative neurologic deficit was Frankel grade D. Fig. B. Preoperative CT scan showed T12 burst fracture and encroachment of spinal canal by body fragment. Fig. C. Postoperative 3.4 year X-ray showed kyphosis was corrected to 5° with neurologic improvement to Frankel grade E.

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  Fig. 3. 79-year-old female with post-traumatic kyphosis after fall down from bed 4 month ago. She was treated with T12 posterior Egg-Shell decompression and T10-L2 posterior interbody fusion. Fig.A. Preoperative X-ray showed severe compression fracture of T12 verbetral body and local kyphosis of 35°. Preoperative neurologic deficit was Frankel grade B. Fig.B. Preoperative MRI showed neural compression at T12 spinal cord. Fig.C. Postoperative 3 year X-ray showed kyphosis was corrected to 8° with neurologic improvement to Frankel grade C.

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