J Korean Soc Spine Surg.  2003 Dec;10(4):321-326.

Surgical Treatment of Osteoporotic Vertebral Fracture with Neurologic Deficits in Thoracolumbar Junction: Comparative Analysis of the Results According to the Surgical Methods

• Kim WJ
• Kang JW
• Yeom JS
• Kim KH
• Kim KJ
• Lee SH
• Choy WS

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To analyze the clinical and radiological results of different surgical methods in osteoporotic vertebral fracture patients, with neurologic deficits in the thoracolumbar junction. SUMMARY OF LITERATURE REVIEW: Various surgical methods have been reported for osteoporotic vertebral fractures, with neurologic deficits, in the thoracolumbar junction. These are: anterior decompression, anterior decompression and anterior or posterior reconstruction, and Egg shell procedure. However, it is controversial as to which method is better.
MATERIALS AND METHODS
13 patients that had undergone surgical treatment for osteoporotic vertebral fractures, with neurologic deficits, With a mean age of 68+/-8.4, ranging from 51 to 79 years. Six of the cases were male and seven were female. The mean follow up period was 18 months. The patients were divided into two groups. Group A (n=8): Anterior decompression, anterior interbody fusion, with cage or autologous strut iliac bone block, and instrumentation (anterior or posterior). Group B (n=5): Posterior decompression and posterior reconstruction (egg shell procedure). The kyphotic angles, neurologic improvements and complications in each group were analyzed preoperatively, postoperatively and at final follow up.
RESULTS
In group A, the mean kyphotic angles were 29+/-5.9 degrees, 18+/-6.7 degrees and 23+/-7.7 degrees preoperatively, postoperatively and at the final follow up, respectively. In group B, the mean kyphotic angles were 31+/-1.1 degrees, 12+/-6.3 degrees and 18+/-5.5 degrees preoperatively, postoperatively and at the final follow up, respectively. In group A, 3 and 5 patients were graded as Frankel grades C and D, respectively. In group B, 1, 1 and 3 patients were graded as Frankel grades B, C and D, respectively. The neurological status improved in all the patients, by mean 1.1 grades in group A and 1.2 grades in group B. In group A, postoperative transient dyspnea and screw loosening occurred in one and two patients, respectively. In group B, postoperative paralytic ileus and screw loosening occurred in one two patients, respectively.
CONCLUSIONS
Posterior decompression and posterior reconstruction (egg shell procedure) was an effective surgical method, equivalent to an anterior or anterior and posterior procedure, for osteoporotic vertebral fracture patients, with neurologic deficits.

MeSH Terms

Animals
Decompression
Dyspnea
Egg Shell
Female
Follow-Up Studies
Humans
Intestinal Pseudo-Obstruction
Male
Neurologic Manifestations*
Retrospective Studies

Figure

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  Fig. 1. Average values of kyphosis correction between two groups.

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  Fig. 2. (A) Improvement of Frankel grade in group A. (B) Improvement of Frankel grade in group B.

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