J Korean Soc Spine Surg.  2017 Jun;24(2):137-145. 10.4184/jkss.2017.24.2.137.

Delayed Vertebral Collapse in Osteoporotic Vertebral Compression Fractures: Risk Factors and Treatment Strategies

• Lee JH
• Shin SJ
• Shin WJ

• KMID: 2385651
• DOI: http://doi.org/10.4184/jkss.2017.24.2.137

Abstract

STUDY DESIGN: Literature review.
OBJECTIVES
To review the complications of osteoporotic vertebral compression fractures (OCFs) with regard to risk factors and treatment strategies. SUMMARY OF LITERATURE REVIEW: Understanding the complications and treatment methods of OCFs is important given their increasing prevalence.
MATERIALS AND METHODS
Review of the literature.
RESULTS
The complications of OCFs include kyphotic deformity due to a delayed collapse of the vertebral body and neurologic deficits. The pathophysiologic mechanism of these complications has not been established; however, the most accepted theory is posttraumatic avascular necrosis of the vertebral body. The risk factors for these complications include fracture at the thoracolumbar junction, systemic usage of steroids, severe osteoporosis, and radiological intravertebral vacuum cleft. Most of these complications require surgical treatment, the indications for which include progressing axial back pain, pseudarthrosis, kyphotic deformity, and neurologic deficits. Surgical approaches for treating the complications of OCFs include anterior, posterior, and combined anterior-posterior approaches. Osteotomies should be done when deformity correction is needed. The decision among these various surgical methods should be made considering patient factors and the surgeon's ability to achieve the best outcomes with solid fusion.
CONCLUSIONS
complications of OCFs include kyphotic deformity due to delayed collapse of the vertebral body and neurologic deficits. Most of these complications require surgical treatment, in which achieving solid fusion at the fracture site is the ultimate goal. Patient-related factors and the surgeon's ability should be considered prior to making decisions regarding surgery.

Keyword

Osteoporotic vertebral compression fracture; Complication; Kyphotic deformity; Avascular necrosis; Deformity correction

MeSH Terms

Back Pain
Congenital Abnormalities
Fractures, Compression*
Humans
Necrosis
Neurologic Manifestations
Osteoporosis
Osteotomy
Prevalence
Pseudarthrosis
Risk Factors*
Steroids
Vacuum
Steroids

Figure

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  Fig. 1. An 83-year-old female developed recent paraplegia accompanied by aggravated back pain 6 months after undergoing kyphoplasty at L1 for an osteoporotic compression fracture. (A) A lateral radiograph demonstrated kyphosis of 33°. (B) Sagittal view of a CT scan 4 months after kyphoplasty at L1, showing a cavity and trabecular disruption in the inferior aspect of the PMMA. (C) Sagittal view of a CT scan 6 months after kyphoplasty at L1, showing breakage of the injected PMMA. (D) T2-weighted MRI shows dural compression by the posterior vertebral body, as well as intravertebral fluid collection around the PMMA, suggesting avascular necrosis at L1. (E) A postoperative radiograph shows the correction of kyphosis to 4° after posterior vertebral column resection. (F) A whole-spine lateral radiograph taken 4 years postoperatively, demonstrating optimal sagittal balance with a well-maintained surgical site. CT, computed tomography; MRI, magnetic resonance imaging; PMMA, polymethylmethacrylate.

• 

  Fig. 2. A 66-year-old female demonstrated recent paraplegia with gradually worsening back pain after an event of slipping down 5 months previously. (A) A whole-spine lateral radiograph shows a severe kyphotic deformity of 50°. (B) T2-weighted MRI shows dural compression at T12-L1. Surgical correction by Steffee osteotomy was performed. (C) A whole-spine lateral radiograph taken 1 year postoperatively demonstrates improvement of the kyphotic deformity to 8°. (D) A sagittal CT scan taken 6 months postoperatively shows solid fusion at the site where osteotomy was performed. MRI, magnetic resonance imaging; CT, computed tomography.

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