1. Article_1130_IJS.cdr

Supra/inter spinous ligament and ligamentum flavum were excised, and a Surgical procedure Osteoporotic vertebral compression fractures (OVCF) are one of the commonest fractures seen in day to day practise. Indications for surgery include the presence of neurological symptoms, persisting pain and deformity. Various modalities of surgical treatment have been described in the form of anterior/ posterior instrumented fusion using pedicle screw instrumentation which is the most popular spinal instrumentation method today [7,20]. She had sustained L1 osteoporotic wedge compression fracture after a trivial fall a year back and was stabilised elsewhere with short segment pedicle screw instrumentation. Her mid back pain persisted (VAS 7/10, ODI74). On giving adequate conservative trial of medications her pain worsened which lead to crouching and inability to stand. On clinical and examination there was an angular kyphosis at the thoracolumbar junction which was tender. X-ray revealed gibbus deformity at L1. A thoraco lumbar facet pain block was tried for the patient due to the significant amount of pain, which provided her temporary relief for 3 months after which her pain recurred (VAS 8/10, ODI80). Her X-ray ( Figure 1) showed partial backing out of screws and osteolysis around the threads in the vertebral body. Her CT scan (Figure 2) showed marginal lysis around the proximal pedicle screws suggestive of implant loosening. Her MRI (Figure 3) did not reveal any neural compression as was confirmed by a normal neurological examination, as the canal was decompressed by laminectomy at the index surgery. Her T score was -5.0. Due to significant kyphosis causing sagittal imbalance and implant loosening she was advised revision surgery in the form of implant removal and fixation with single spinal rectangular loop and sublaminar wires (SLW). Introduction