Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2007 Jun;14(2):73-78. Korean.
    Published online Jun 30, 2007.
    https://doi.org/10.4184/jkss.2007.14.2.73
    Copyright © 2007 Korean Society of Spine Surgery
    Original Article

    Operative Treatment of Delayed Collapse of Osteoporotic Vertebral Fracture with Claudication - Transpedicular Bone Graft and Pedicle Screw Fixation -

    Dae Jeong Choi, M.D., Dong Ki Ahn, M.D., Song Lee, M.D., Kwan Young Park, M.D., Young Won Jun, M.D. and Kwan Soo Kim, M.D.
      • Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea.
    • Address reprint requests to: Dong Ki Ahn, M.D. Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, 40-12 Chungryangri-dong, Dongdaemoon-gu, Seoul, Korea. Tel: 82-2-966-1616, Fax: 82-2-968-2394, Email: adkajs@hanmail.net

    Abstract

    Study Design

    Retrospective study.

    Objectives

    To evaluate the efficacy of transpedicular bone graft and pedicle screw fixation in delayed collapse of osteoporotic vertebral fracture with claudication.

    Summary of the Literature Review

    Delayed collapse of osteoporotic vertebral fracture may result in seemingly unrelenting back pain and neurologic deficits. Though there are many surgical options for such cases, comprehensive improvement of symptoms is uncertain.

    Materials and Methods

    Nineteen patients who underwent operation and were followed-up for more than 2 years were studied. The regional sagittal angle, restoration ratio of the vertebral body, standing sagittal balance, and additional fracture were assessed. Improvement of back and leg pain was assessed using 10 point Visual Analog Scales (VAS). The causes of sustained clinical symptoms were analyzed.

    Results

    The regional sagittal angle was corrected from 25.2±13.9° to 12.4±10.4° (p=0.000). The vertebral body ratio was restored from 36±14.1% to 72±16.7% (p=0.000). Six cases were found to be neutral and 13 cases showed a positive sagittal balance. Additional fractures were found in 11 cases. The VAS value for leg pain was improved from 6.6±1.0 to 1.0±1.1 (p=0.000), while that for back pain was not improved (6.4±1.7 to 7.1±2.3, p=0.474). Positive sagittal balance was a significant risk factor (p=0.037, odds ratio=58.084) for sustained back pain.

    Conclusion

    For the treatment of delayed collapse of osteoporotic vertebral fracture with claudication, transpedicular bone graft and pedicle screw fixation was effective in improving claudication and restoring the vertebral body and regional sagittal angle. However, it was not capable of alleviating back pain. Positive sagittal balance was considered to be a cause of sustained back pain.

    Keywords
    Osteoporotic vertebral fracture; Delayed collapse; Transpedicular bone graft

    Figures

    Fig. 1
    Photographs of the pedicle reamer and end plate elevator which are used for extension of interbody space.

    Fig. 2
    Regional sagital angles were estimated by Cobb's method which is consist of upper end plate of upper vertebra and lower end plate of lower vertebra adjacent to collapsed vertebral body.

    Fig. 3
    These are images of 73 year old male patient with delayed collapse of osteporotic vertebral fracture with claudication. (A) Initial lateral radiograph shows cleft in L1 body. (B) Initial T2-weighted MRI film demonstrates not only vertebral body collapse but also neural canal encroachment. (C) Immediate postoperative lateral radiograph shows restoration of regional sagittal angle and body height. (D) Postoperative 31 months lateral radiograph shows maintenance of correction angle. (E) Postoperative 31 months T2-weighted MRI shows solid union of body and decompressed neural canal. (F) Postoperative 31 months whole spine standing lateral radiograph shows neutral sagittal balance.

    Tables

    Table 1
    Fracture site

    References

      1. Ito Y, Hasegawa Y, Toda K, Nakahara S. Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture. Spine J 2002;2:101–106.
      1. Kim KT, Suk KS, Kim JM, Lee SH. Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop 2003;27:65–69.
      1. 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.
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      1. Alanay A, Acaroglu E, Yazici M, Aksoy C, Surat A. The effect of transpedicular intracorporeal grafting in the treatment of thoracolumbar burst fractures on canal remodeling. Eur Spine J 2001;10:512–516.
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      1. Knop C, Fabian HF, Bastian L, et al. Fate of the transpedicular intervertebral bone graft after posterior stabilization of thoracolumbar fractures. Eur Spine J 2002;11:251–257.
      1. Leferink VJ, Zimmerman KW, Veldhuis EF, ten Vergert EM, ten Duis HJ. Thoracolumbar spinal fractures: radiological results of transpedicular fixation combined with transpedicular cancellous bone graft and posterior fusion in 183 patients. Eur Spine J 2001;10:517–523.
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    MeSH Terms
    Back Pain
    Humans
    Leg
    Neurologic Manifestations
    Retrospective Studies
    Risk Factors
    Transplants*
    Visual Analog Scale
    Metrics
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