J Korean Soc Spine Surg.  2007 Dec;14(4):243-248.

Analysis for Etiology of Correction Loss after Surgical Treatment of Osteoporotic Vertebral Fracture with Neurologic Deficits

• Kim WJ
• Kang JW
• Sung HI
• Park JG
• Park KY
• Kang SI
• Choy WS

Abstract

STUDY DESIGN: A retrospective radiologic study of 23 cases
OBJECTIVES
This study evaluated the etiology of correction loss after surgical treatment of osteoporotic vertebral fractures with neurologic deficits SUMMARY OF LITERATURE REVIEW: osteoporotic vertebral fractures with neurologic deficits were treated with anterior decompression with posterior instrumentation or an Egg shell operation.
MATERIALS AND METHODS
We experienced 23 cases treated surgically for osteoporotic vertebral fracture with neurologic deficits. In group A (16 cases), anterior decompression with posterior instrumentation were performed, with group B (7 cases) receiving an Egg shell operation. The kyphotic angle using Cobb's method and endplate injury were evaluated preoperatively, postoperatively, and at last follow up. Group A was subdivided into A1 and A2 according to preoperative and postoperative kyphotic angle, as well as being divided by endplate injury into subgroup a and b. Overcorrection of preoperative kyphotic angles were performed in A1, and undercorrection in A2 group, with endplate injury in subgroup a.
RESULTS
Postoperative correction was 13.4 degrees+/-3.4degrees and correction loss was 9.68degrees+/-8.05degrees in group A, and 21.5degrees+/-5.0degrees and 8.0degrees+/-1.73degrees in group B, respectively. Correction loss of group A1 (13.4degrees +/-8.8degrees ) was significantly larger than A2 (4.71degrees +/-3.14degrees ) (p=0.011). The correction loss of group A1a (18.0degrees +/-9.3degrees ) was significantly larger than group A2 (8.5degrees +/-3.1degrees ) (p=0.050) and A2a (p=0.036). The correction loss of group A1b was significantly larger than group A2b (p=0.029), and correction losses were not significantly different in A2a (6.0degrees +/-4.0degrees ) and A2b (3.25degrees +/-1.7degrees ) (p=0.289).
CONCLUSIONS
Less Correction loss was found in the undercorrection and non-endplate injury group

Keyword

Osteoporosis; Correction loss; Vertebral fracture; Extension lateral radiography; Surgical treatment

MeSH Terms

Animals
Decompression
Egg Shell
Follow-Up Studies
Neurologic Manifestations*
Osteoporosis
Retrospective Studies

Figure

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  Fig. 1. Cobb's angle of adjacent level in lateral spine radiography. (A) pre-op lateral, (B) pre-op lateral extension, (C) (D) intra-op lateral with kyphosis correction.

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  Fig. 2. Average values of kyphosis correction and correction loss (percentage) between Group A and B.

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  Fig. 3. Average values of kyphosis correction loss between A1 and A2

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  Fig. 4. Average values of kyphosis correction loss of Group A1 and A2 according to endplate injury

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  Fig. 5. Average values of kyphosis correction loss of subgroup a and b according to kyphosis correction.

Reference

1). Ha KY, Ryoo SJ, Yoon HM. Anterior Decompression and Fusion with Instrumentation in Osteoporotic Vertebral Fracture. J Kor Soc Spine Surg. 2003; 10:311–320.

2). Kaneda K, Asano S, Hashimoto T, Satoh S, Fujiya M. The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and bioactive ceramic vertebral prosthesis. Spine. 1992; 17:295–303.

3). Riew KD, Rhee JM. The use of titanium mesh cages in the cervical spine. Clin Orthop. 2002; 394:47–54.

4). Suk SI, Kim JH, Chung ER, et al. Surgical Treatment of Post-Traumatic Kyphosis with Neurologic Compromised Osteoporotic Fracture - Comparison between Anterior-Posterior Surgery versus Posterior Egg-Shell Procedure. J Kor Soc Spine Surg. 2002; 9:148–156.

5). Shikata J, Yamamuro T, Iida H, Shimizu K, Yoshikawa J. Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis. Spine. 1990; 15:485–489.

6). Kim KT, Suk KS, Kim JM. Surgical treatment of Kum-mell disease with neurologic deficits. J Kor Spine Surg. 2001; 8:136–142.

7). Heinig CF, Boyd BM. One stage vertebrectomy or eggshell procedure. Orthop Trans. 1985; 9:130.

8). Gurr KR, McAfee PC, Shih CM. Biomechanical analysis of anterior posterior instrumentation systems after corpectomy. A calf-spine model. J Bone Joint Surg Am. 1988; 70:1182–1191.

9). Lee SH, Kim YB, Lee ST, Kim TS, Oh KJ, Na JI. Treatment of Osteoporotic Vertebral Collapses of the Thoracolumbar Spine with Neurologic Deficits using Anterior Approach. J Kor Soc Spine Surg. 2003; 10:172–179.

10). Suk SI, Lee CK, Yoon KS, Lee JH, Kim WJ, Moon SH. Surgical Treatment in Delayed Posttraumatic Thoracolumbar Kyphosis. J Korean Orthop Assoc. 1995; 30:1647–1655.

11). Kaplan PA, Orton DF, Asleson RJ. Osteoporosis with vertebral compression fractures, retropulsed fragments, and neurologic compromise. Radiology. 1987; 165:533–535.

12). Salomon C, Chopin D, Benoist M. Spinal cord compression: an exceptional complicaton of spinal osteoporosis. Spine. 1988; 13:222–224.

13). Roberson JR, Whitesides TE Jr. Surgical reconstruction of late post-traumatic thoracolumbar kyphosis. Spine. 1985; 10(4):307–312.

14). Lee YL, Yip KM. The osteoporotic spine. Clin Orthop. 1996; 323:91–97.

15). Kim WJ, Kang JW, Yeom JS, et al. Surgical treatment of osteoporotic vertebral fracture with neurologic deficits in thoracolumbar junction-Comparative analysis of the results according to the surgical methods. J Kor Spine Surg. 2003; 10:321–326.

16). Taneichi H, Kaneda K, Oguma T, et al. Risk factor analysis for osteoporotic vertebral collapse and pseudoarthrosis, Clinical Orhtop Surg. 2002; 37:437–442.

17). HU SS. Internal fixation in the osteoporotic spine. Spine. 1997; 22:958–963.

18). Hasegawa K, Takahashi HE, Uchiyama S, et al. An experimental study of a combination method using a pedicle screw and laminar hook for the osteoporotic spine. Spine. 1997; 22:958–963.

19). Glassman SD, Alegre GM. Adult spinal deformity in the osteoporotic spine: options and pitfalls. Instr Course Lect. 2003; 52:579–588.