J Korean Soc Spine Surg.  2003 Dec;10(4):311-320.

Anterior Decompression and Fusion with Instrumentation in Osteoporotic Vertebral Fracture

• Ha KY
• Ryoo SJ
• Yoon HM

Abstract

STUDY DESIGN: A Retrospective study
OBJECTIVE
To evaluate the results after an anterior decompression and fusion, with anterior instrumentation, using a Z-plate in osteoporotic vertebral fractures. SUMMARY OF LITERATURE REVIEW: Despite conservative treatment, continuous severe pain, progressive neurological impairments and deformity may need surgical treatment in osteoporotic vertebral fractures accompanied with neurological deficit.
MATERIALS AND METHODS
Fourteen patients that had undergone anterior decompression and an autogenous iliac bone graft, with anterior internal fixation, between 1997 and 2001, under the diagnosis of an osteoporotic vertebral fracture, were reviewed. The chief complaints, severity of pain measured, using the Denis pain scale, fracture patterns, fracture level, changes of kyphotic angle (revised with sagittal index) and complications were analyzed.
RESULTS
Symptoms subsided completely in 5 patients, one case showed no definite improvement and 8 showed improved symptoms. The fracture levels included: 1 and 2 cases at the 11th and 12th thoracic spine, and 8, 1 and 2 in the 1st, 2nd and 3rd lumbar spine, respectively. 10 patients showed wedge type fractures, three a compression type and one a biconcave type. The average kyphotic deformity decreased 49.0% (50.9% when revised with sagittal index) after surgery, but the average loss of correction angle was 28.8% (26.0% when revised with sagittal index), compared with the immediate postoperative correction angle. THE COMPLICATIONS INCLUDED: screw loosening and adjacent vertebral fractures in 3 and 4 patients, respectively. Two patients had the combined problem of screw loosening and an adjacent vertebral fracture.
CONCLUSION
In anterior decompression and fusion, with instrumentation, for osteoporotic vertebral fracture treatment, the complications were primarily related, directly or indirectly, to the underlying osteoporosis. Complete neurological recovery occurred 9 of the 11 patients, but residual pain was common.

Keyword

Thoracolumbar; Osteoporosis; Vertebral fracture; Kyphotic angle; Anterior fusion

MeSH Terms

Congenital Abnormalities
Decompression*
Diagnosis
Humans
Osteoporosis
Retrospective Studies
Spine
Transplants

Figure

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  Fig. 1. Classification of osteoporotic vertebral fractures by type (A) Wedge deformity, (B) Biconcavity deformity, (C) Compression deformity

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  Fig. 2. Change of average degrees of kyphotic deformity (revised with sagittal index)

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  Fig. 3. Change of average t-value (BMD)

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  Fig. 4. Comparison of t-value of osteoporosis complication and non-complication case: there is no statistical significance (p > 0.05) (Mean: average t-value of whole cases No Cx: average t-value of cases without complications AV Fx: average t-value of cases which show adjacent vertebral fracture SL: average t-value of cases which show screw loosening)

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  Fig. 5. showing screw loosening (white arrow)

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  Fig. 6. showing both screw loosening and fracture at adjacent vertebrae

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