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KMID : 0388720070140020073
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Journal of Korean Society of Spine Surgery
2007 Volume.14 No. 2 p.73 ~ p.78
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Operative Treatment of Delayed Collapse of Osteoporotic Vertebral Fracture with Claudication -Transpedicular Bone Graft and Pedicle Screw Fixation-
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Choi Dae-Jung
Ahn Dong-Ki
Lee Song
Park Kwan-Young
Jeon Young-Won
Kim Kwan-Soo
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Abstract
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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 literture 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+/-13.9degrees to 12.4+/-10.4degrees (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.
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KEYWORD
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Osteoporotic vertebral fracture, Delayed collapse, Transpedicular bone graft
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