J Korean Orthop Assoc.  2008 Dec;43(6):791-798.

Posterior Surgery of Neurologically Compromised Osteoporotic Kyphosis: Posterolateral Decompression and Stabilization using Titanium Mesh

• Lee JH
• Kim KT
• Suk KS
• Lee SH
• Hwang DW
• Kim JS
• Shin JH
• Hong WS
• Eoh JH
• Kwak YH

Abstract

PURPOSE: Several treatment options have been reported for post-traumatic kyphosis (PTK) and neurologically compromised osteoporotic fractures. However, there is no ideal surgical procedure. This study evaluated the effectiveness of posterolateral decompression and anterior support with a titanium mesh in PTK by posterior surgery.
MATERIALS AND METHODS
Seventeen patients with PTK and neurologically compromised osteoporotic fractures underwent a single posterior approach. During posterior decompression, a titanium mesh was inserted through the posterior approach after a transpedicular intracorporeal corpectomy. Complications, operating time and blood loss were noted, and radiographic studies and neurological status were evaluated before surgery, after surgery, and at final follow-up.
RESULTS
The mean kyphosis was 35+/-9.7degrees (range; 17-58degrees) before surgery, 3.2+/-1.8degrees after surgery (correction; 90.5%) and 5.5+/-3.2degrees at the final follow-up (correction; 85.5%). There was 29.6degrees correction of the kyphosis with a 6% loss of correction. Postoperative neurological improvement using the Frankel classification was demonstrated in all patients. There was no new onset or progressive neurological deterioration, additional surgery or extrusion of mesh. Three complications were encountered: one care each of pneumonia, prolonged ventilator support and distal adjacent vertebral fracture.
CONCLUSION
The posterior insertion of a titanium mesh for anterior support appears to maintain the length of the anterior column, stabilize the injured vertebra and facilitate spinal fusion. Posterolateral decompression allows as direct a decompression as the anterior approach.

Keyword

Osteoporosis; Posttraumatic kyphosis; Neurologic compromise; Posteiror approach; Pedicle screw; Titanium mesh

MeSH Terms

Decompression
Follow-Up Studies
Humans
Kyphosis
Osteoporosis
Osteoporotic Fractures
Pneumonia
Spinal Fusion
Spine
Titanium
Ventilators, Mechanical
Titanium

Figure

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  Fig. 1 77-year-old female sustained a L1 compression fracture 1 year earlier. She presented with post-traumatic kyphosis and neurological compromise that had developed 3 months earlier. (A) Preoperative radiographs show a burst out and kyphotic deformity on the standing radiographs and a vacuum cleft of L1 on the recumbent radiograph. Preoperative neurological deficit was Frankel grade C. (B) T2-weighted sagittal MR image shows retropulsed bony fragments into the spinal canal and avascular necrosis on the T12 and L1 body. (C) The axial MR image shows compression of the spinal cord at the L1 level.

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  Fig. 2 (A) Postoperative radiographs show that the kyphosis was corrected to 0°. (B) The postoperative radiographs taken three years after surgery show that the reconstructed portion of the spine is stable with the correction of kyphosis being maintained.

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  Fig. 3 64-year-old female was injured by slip down and sustained a L1 compression fracture 2 months before presentation. Before presentation at our facility, she was treated with kyphoplasty and presented to our institution with severe back pain and paraparesis that developed one month after kyphoplasty. (A) Post-trauma lateral radiograph. (B) Radiograph taken 2 weeks after the injury shows a collapse of the vertebral body. (C) Immediate lateral radiograph after kyphoplasty. (D) Preoperative lateral radiograph shows the collapsed vertebral body at L1 with 32° of kyphosis. The patient had Frankel grade D before surgery. (E) The preoperative MR images show the avascular necrosis of the L1 body, retropulsed bony fragments into the spinal canal and neural compression at the level of L1.

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  Fig. 4 (A) Intraoperative findings; working space made by pedicle subtraction (empty arrow), extraction of cement mass through the space (short arrow), covering of interlaminar defect with splitted interspinous process following transpedicular intracoporeal corpectomy and rods fixation (long arrow) and posterior fusion (dotted arrow). (B) Cement mass from vertebral body. (C) 3D-reconstruction CT sacns show the reconstructed portion of the spine is stable and the correction of kyphosis is well maintained. (D) Postoperative radiographs tatken sixteen months after the surgery show that kyphosis was corrected to 0°.

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