Treatment strategy for osteoporotic vertebral body fractures in the lumbar spine: a case report and literature review

This report describes the successful treatment of an osteoporotic compression fracture. A 74-year-old woman presented with severe low back pain and left sciatica that had lasted for 6 weeks. Four week of conservative treatment was not effective. The patient was bedridden and had difficulty walking. A past history of osteoporosis was noted. Multilevel compression fractures, central stenosis, and spondylolisthesis with overt instability were evident in the preoperative images. Decompression and fusion surgery, vertebroplasty, and preoperative and postoperative teriparatide administration were planned. A severe endplate injury in the lower vertebral body was detected during interbody fusion surgery using an anterior approach. Additional screw insertion with posterolateral fusion was planned to prevent aggravation of cage subsidence. Postoperative magnetic resonance imaging, computed tomography (CT), and X-ray images revealed sufficient decompression, no cement leakage, and no nerve injury. On the first postoperative day, the patient reported that the left sciatica symptoms had improved. Satisfactory ambulation was observed at the outpatient department after 6 months. Fusion in progress was evident on follow-up CT and X-ray images. This case offers insights into possible treatment strategies for osteoporotic compression fractures with severe endplate injury, overt instability, and radiculopathy of the lower lumbar spine.

[1]  T. Xie,et al.  Clinical and radiological evaluation of cage subsidence following oblique lumbar interbody fusion combined with anterolateral fixation , 2022, BMC Musculoskeletal Disorders.

[2]  R. Rodrigues-Pinto,et al.  Risk factors for cage subsidence and clinical outcomes after transforaminal and posterior lumbar interbody fusion , 2021, European Journal of Orthopaedic Surgery & Traumatology.

[3]  B. Blondel,et al.  Treatment of osteoporotic vertebral fractures. , 2020, Orthopaedics & traumatology, surgery & research : OTSR.

[4]  John H. Shin,et al.  Assessment of the efficacy of teriparatide treatment for osteoporosis on lumbar fusion surgery outcomes: a systematic review and meta-analysis , 2020, Neurosurgical Review.

[5]  Chien-Lin Liu,et al.  Risk Factors of Cage Subsidence in Patients Received Minimally Invasive Transforaminal Lumbar Interbody Fusion. , 2020, Spine.

[6]  D. Liang,et al.  Effect and potential risks of using multilevel cement-augmented pedicle screw fixation in osteoporotic spine with lumbar degenerative disease , 2020, BMC Musculoskeletal Disorders.

[7]  H. Terai,et al.  The Surgical Outcomes of Spinal Fusion for Osteoporotic Vertebral Fractures in the Lower Lumbar Spine with a Neurological Deficit , 2020, Spine surgery and related research.

[8]  Wencheng Yang,et al.  Functional outcomes and new vertebral fractures in percutaneous vertebroplasty and conservative treatment for acute symptomatic osteoporotic vertebra compression fractures. , 2019, World neurosurgery.

[9]  Victor W. Chang,et al.  Subsidence Rates After Lateral Lumbar Interbody Fusion: A Systematic Review. , 2019, World neurosurgery.

[10]  M. Bydon,et al.  Incidence of Osteoporosis-Related Complications Following Posterior Lumbar Fusion , 2017, Global spine journal.

[11]  A. Goregaonkar,et al.  Conservative Management of Osteoporotic Vertebral Fractures: A Prospective Study of Thirty Patients , 2016, Cureus.

[12]  A. Ortiz,et al.  Injury to the Vertebral Endplate-Disk Complex Associated with Osteoporotic Vertebral Compression Fractures , 2010, American Journal of Neuroradiology.

[13]  R. Molinari,et al.  Posterior Lumbar Interbody Fusion , 2008, The Journal of the American Academy of Orthopaedic Surgeons.

[14]  Jacques P. Brown,et al.  Recognizing and reporting vertebral fractures: reducing the risk of future osteoporotic fractures. , 2007, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[15]  M. Nevitt,et al.  Association of prevalent vertebral fractures, bone density, and alendronate treatment with incident vertebral fractures: effect of number and spinal location of fractures. The Fracture Intervention Trial Research Group. , 1999, Bone.

[16]  J Dequeker,et al.  Bone Density Variation and Its Effects on Risk of Vertebral Deformity in Men and Women Studied in Thirteen European Centers: The EVOS Study , 1997, Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research.