J Korean Orthop Assoc.  2022 Aug;57(4):315-325. 10.4055/jkoa.2022.57.4.315.

Posterior Surgery with Selective Anterior Reinforcement and Screw Augmentation for a Delayed Myelopathy from an Osteoporotic Vertebral Compression Fracture

• Kim JH
• Ahn DK
• Shin WS
• Cho KJ
• Kim S
• Jung J

• KMID: 2532413
• DOI: http://doi.org/10.4055/jkoa.2022.57.4.315

Abstract

Purpose
In delayed myelopathy (DM) from osteoporotic vertebral compression fractures (OVCF), the mechanisms of spinal cord impingement differ according to the stability of the fractured vertebra. This study examined the availability of a posterior surgery comprised of pedicle screw augmentation with polymethylmethacrylate (PMMA) and selective anterior reinforcement (PS-PMMA+SAR) according to the stability.
Materials and Methods
This was a retrospective single-center study. The consecutive patients who had a PS-PMMA+SAR for a DM from OVCF and were followed up more than two years were reviewed. Thirty patients were eligible for this study. All patients used fenestrated screws for PMMA augmentation. Anterior reinforcement was selected according to the stability. The unstable type was done by filling the vacuum cleft with bone chips or PMMA, and the stable type was done by vertebral body anterior translation with/without an interbody bone graft. The radiological and functional outcomes were evaluated.
Results
There were 20 unstable and 10 stable cases. The regional kyphotic angle was improved significantly from 31.3°±10.8° to 10.4°±8.3° (p<0.001). The anterior vertebral height ratio was improved significantly from 39.4%±17.1% to 86.4%±9.2% (p<0.001). The spinal canal invasion ratio was improved significantly from 39.2%±14.8% to 19.1%±10.8% (p<0.001). The walking ability was improved mostly by two Nurick’s grades (p<0.001). The Oswestry disability index was improved from 72% to 33% (p<0.001).
Conclusion
Posterior surgery with PMMA-augmented pedicle screws, and selective anterior reinforcement for DM from OVCF was available to achieve a good functional and radiological outcome.

Keyword

delayed myelopathy; osteoporotic vertebral compression fracture; posterior surgery; selective anterior reinforcement; screw augmentation