Journal of Orthopedics and Joint Surgery

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VOLUME 4 , ISSUE 1 ( January-June, 2022 ) > List of Articles

Original Article

Delayed Neurological Deficit in Osteoporotic Vertebral Compression Fracture: An Analysis of Surgical Outcome

Thirumalai Murugan, Arivasan Rathinam, Sathiya Prakash

Keywords : Delayed neurological deficit, Nonunion, Osteoporosis, Osteoporotic vertebral fractures, Vertebroplasty

Citation Information : Murugan T, Rathinam A, Prakash S. Delayed Neurological Deficit in Osteoporotic Vertebral Compression Fracture: An Analysis of Surgical Outcome. 2022; 4 (1):14-18.

DOI: 10.5005/jp-journals-10079-1080

License: CC BY-NC 4.0

Published Online: 28-01-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: The International Osteoporosis Foundation has estimated that worldwide, approximately 30–50% of people aged over 50 years are at risk for the development of fragility fractures secondary to osteoporosis. Vertebral compression fractures occur in 20% of people older than 70 years and in 16% of postmenopausal women. The majority of fractures heal with conservative treatment after 8–10 weeks. Surgery is indicated for patients who present with neurological deficits, deformities, and incapacitating pain with conservative treatment failure. Two percent of patients with osteoporotic vertebral fractures (OVFs) develop cord compression. This study aimed to identify the clinical presentation and predictors of clinical outcomes among patients operated for delayed neurological deficits after OVFs. Materials and methods: eight cases—five women, three men, dorsolumbar junction—seven cases, dorsal spine one case. Neurological status – ASIA B – 1 – ASIA C – 5 – ASIA D – 2. All cases underwent posterior short segment fixation (pedicle screws one level above and below the fracture vertebra) and percutaneous vertebroplasty and indirect decompression. Results and analysis: Postoperatively neurology improved up to ASIA grade E – 7, grade D – 1. All patients were followed up with neurological assessment every 2 weeks up to 3 months and every month up to 6 months. One patient could not walk, and seven patients walked with assistance. Two patients had sphincter disturbance. The mean preoperative Baba\'s score was 6 and postoperative score was 11 after follow-up. The mean values of lateral anterior vertebral body height (LAH) were 41.0% preoperatively and 60.7% postoperatively, and lateral posterior vertebral body height (LPH) were 37.4% preoperatively and 58.8% after 6 months postoperatively. The average retropulsion was 36.5%. Conclusion: Although OVFs are common and generally considered benign, severe and delayed neurological deficits can occur following spinal cord compression. In experienced hands and with appropriate patient selection, posterior short segment fixation (PSF) and vertebroplasty is a safe and efficacious procedure for the treatment of osteoporotic compression fractures with neurological deficit.


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  1. Kung AW, Lee KK, Ho AY, et al. Ten-year risk of osteoporotic fractures in postmenopausal Chinese women according to clinical risk factors and BMD T-scores: a prospective study. J Bone Miner Res 2007;22:1080–1087. DOI: 10.1359/jbmr.070320
  2. Ho SC, Lau EM, Woo J, et al. The prevalence of osteoporosis in the Hong Kong Chinese female population. Maturitas 1999;32:171–178. DOI: 10.1016/s0378-5122(99)00026-2
  3. Kwok AW, Gong JS, Wang YX, et al. Prevalence and risk factors of radiographic vertebral fractures in elderly Chinese men and women: results of Mr. OS (Hong Kong) and Ms. OS (Hong Kong) studies. Osteoporos Int 2013;24:877–885. DOI: 10.1007/s00198-012-2040-8
  4. Rousing R, Hansen KL, Andersen MO, et al. Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertebroplasty: a clinical randomized study. Spine (Phila Pa 1976) 2010;35:478–482. DOI: 10.1097/BRS.0b013e3181b71bd1
  5. Lee YL, Yip KM. The osteoporotic spine. Clin Orthop Relat Res 1996;323:91–97. DOI: 10.1097/00003086-199602000-00012
  6. Baba H, Maezawa Y, Kamitani K, et al. Osteoporotic vertebral collapse with late neurological complications. Paraplegia 1995;33:281–289. DOI: 10.1038/sc.1995.64
  7. Kempinsky WH, Morgan PP, Boniface WR. Osteoporotic kyphosis with paraplegia. Neurology 1958;8:181–186. DOI: 10.1212/WNL.8.3.181
  8. Cortet B, Solau-Gervais E, Labbe P, et al. Osteoporotic vertebral crush fractures with severe neurologic manifestations: apropos of 6 cases. Rev Med Interne 1995;16:891–896. DOI: 10.1016/0248- 8663(96)80809-5
  9. Hoshino M, Nakamura H, Terai H, et al. Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture. Eur Spine J 2009;18:1279–1286. DOI: 10.1007/s00586-009-1041-6
  10. Heggeness MH. Spine fracture with neurological deficit in osteoporosis. Osteoporos Int 1993;3:215–221. DOI: 10.1007/BF01623679
  11. Ito Y, Hasegawa Y, Toda K, et al. Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture. Spine J 2002;2:101–106. DOI: 10.1016/s1529-9430(01)00165-6
  12. Mori S, Norimatsu H, Oka S. Burst fracture: osteoporotic vertebral compression fracture associated with paraplegia. Nihon Rinsho 1994;52:2435–2441.
  13. Moraes FB, Oliveira LG, Novais Pde S, et al. Correlation between calcaneal bone ultrasound measurements and densitometry among postmenopausal women with fractures caused by bone fragility. Rev Bras Ortop 2011;46:139–142. DOI: 10.1016/S2255- 4971(15)30229-9
  14. Saita K, Hoshino Y, Higashi T, et al. Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis. Spinal Cord 2008;46:16–20. DOI: 10.1038/sj.sc.3102052
  15. Kim KT, Suk KS, Kim JM, et al. Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop 2003;27:65–69. DOI: 10.1007/s00264-002-0418-5
  16. Lee SH, Kim ES, Eoh W. Cement augmented anterior reconstruction with short posterior instrumentation: a less invasive surgical option for Kummell's disease with cord compression. J Clin Neurosci 2011;18:509–514. DOI: 10.1016/j.jocn.2010.07.139
  17. Uchida K, Kobayashi S, Matsuzaki M, et al. Anterior versus posterior surgery for osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine. Eur Spine J 2006;15:1759–1767. DOI: 10.1007/s00586-006-0106-z
  18. Nguyen HV, Ludwig S, Gelb D. Osteoporotic vertebral burst fractures with neurologic compromise. J Spinal Disord Tech 2003;16:10–19. DOI: 10.1097/00024720-200302000-00003
  19. Lau EM, Chan HH, Woo J, et al. Body composition and bone mineral density of Chinese women with vertebral fracture. Bone 1996;19:657–662. DOI: 10.1016/s8756-3282(96)00279-7
  20. Siris ES, Adler R, Bilezikian J, et al. The clinical diagnosis of osteoporosis: a position statement from the National Bone Health Alliance Working Group. Osteoporos Int 2014;25:1439–1443. DOI: 10.1007/s00198-014-2655-z
  21. Kruger MC, Todd JM, Schollum LM, et al. Bone health comparison in seven Asian countries using calcaneal ultrasound. BMC Musculoskelet 2013;14:81. DOI: 10.1186/1471-2474-14-81
  22. Alpantaki K, Dohm M, Korovessis P, et al. Surgical options for osteoporotic vertebral compression fractures complicated with spinal deformity and neurologic deficit. Injury 2018; 49(2):261–271. DOI: 10.1016/j.injury.2017.11.008
  23. Yeung YK, Ho ST. Delayed neurological deficits after osteoporotic vertebral fractures: clinical outcomes after surgery. Asian Spine J 2017;11(6):981–988. DOI: 10.4184/asj.2017.11.6.981
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