Lightning Podiums: Value and Outcomes in Spinal Surgery - Room 801B

Presented by: J.-Y. Seo

Author(s):

J.-Y. Seo(1), K.-Y. Ha(2), Y.-H. Kim(2), S.-I. Kim(2)

(1) Jeju National University Hospital, Department of Orthopaedic Surgery, Jeju, Korea, Republic of
(2) Seoul St. Mary's Hospital, Orthopaedic Surgery, Seoul, Korea, Republic of

Abstract

Purpose: Osteoporotic vertebral fractures (OVFs) associated with neurological compromise have become increasingly common. We investigated the clinical and radiological characteristics of these complicated OVFs.

Methods: Between January 2008 and December 2014, patients who developed myelopathy during treatment for osteoporotic thoracolumbar vertebral fractures were investigated. Twenty-five patients (M:F ratio = 7:18) with a mean age of 73.9 ± 7.1 years were enrolled. Patients were grouped, according to the surgical approach, into an anterior decompression group and a posterior decompression group. The height loss and kyphotic angle of the affected vertebral body were measured on consecutive radiographs. Clinical outcomes were assessed using a visual analog scale and the Oswestry disability index.

Results: The mean interval from the initial diagnosis of OVF to decompressive surgery was 9.9 ± 10.0 weeks. Delayed myelopathy developing after OVF usually occurred at the thoracolumbar junction. Preoperative radiographic studies identified intravertebral clefts in 14 of the 25 patients (56%). Six patients (24%) underwent cement augmentation prior to the development of neurological impairment; of these, five developed non-union accompanied by peri-cement osteolysis. Two patients (8%) experienced ossification of the yellow ligament around the fractured vertebra. Even after reconstructive surgery, some loss of correction (in terms of vertebral height and kyphosis) was inevitable. However, improvements in terms of clinical outcomes were possible in most patients.

Conclusions: OVF with a delayed neurological deficit developed after non-union upon the appearance of an intravertebral cleft associated with fracture instability, upon progression of kyphosis, and on failure of cement augmentation. If a fracture develops at the thoracolumbar junction in an elderly patient, any pre-existing stenotic lesion should first be identified. Furthermore, any intravertebral cleft, accompanied by instability on follow-up radiographic examination, should be identified. Preventative reconstructive surgery is recommended for such patients. Appropriate reconstructive surgery (thus considering both age and bone quality) can be helpful to avoid debilitating complications.