Surgical Intervention for Osteoporotic Vertebral Burst Fractures in Middle-low Lumbar Spine with Special Reference to Postoperative Complications Affecting Surgical Outcomes

The purpose of this study was to investigate the clinical and radiological features of osteoporotic burst fractures affecting levels below the second lumbar (middle-low lumbar) vertebrae, and to clarify the appropriate surgical procedure to avoid postoperative complications. Thirty-eight consecutive patients (nine male, 29 female; mean age: 74.8 years; range: 60–86 years) with burst fractures affecting the middle-low lumbar vertebrae who underwent posterior-instrumented fusion were included. Using the Magerl classification system, these fractures were classified into three types: 16 patients with superior incomplete burst fracture (superior-type), 11 patients with inferior incomplete burst fracture (inferior-type) and 11 patients with complete burst fracture (complete-type). The clinical features were investigated for each type, and postoperative complications such as postoperative vertebral collapse (PVC) and instrumentation failure were assessed after a mean follow-up period of 3.1 years (range: 1–8.1 years). All patients suffered from severe leg pain by radiculopathy, except one with superior-type fracture who exhibited cauda equina syndrome. Nineteen of 27 patients with superior- or inferior-type fracture were found to have spondylolisthesis due to segmental instability. Although postoperative neurological status improved significantly, lumbar lordosis and segmental lordosis at the fused level deteriorated from the postoperative period to the final follow-up due to postoperative complications caused mainly by PVC (29%) and instrument failure (37%). Posterior-instrumented fusion led to a good clinical outcome; however, a higher incidence of postoperative complications due to bone fragility was inevitable. Therefore, short-segment instrument and fusion with some augumentation techniqus, together with strong osteoporotic medications may be required to avoid such complications.

[1]  V. Deviren,et al.  The relationship of older age and perioperative outcomes following thoracolumbar three-column osteotomy for adult spinal deformity: an analysis of 300 consecutive cases. , 2018, Journal of neurosurgery. Spine.

[2]  P. Cinnella,et al.  Surgical treatment of osteoporotic thoraco-lumbar compressive fractures: the use of pedicle screw with augmentation PMMA , 2017, European Spine Journal.

[3]  H. Baba,et al.  Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience. , 2016, Journal of neurosurgery. Spine.

[4]  Gyu Yeul Ji,et al.  An effect comparison of teriparatide and bisphosphonate on posterior lumbar interbody fusion in patients with osteoporosis: a prospective cohort study and preliminary data , 2017, European Spine Journal.

[5]  H. Sakaura,et al.  Modified Posterior Lumbar Interbody Fusion for Radiculopathy Following Healed Vertebral Collapse of the Middle-Lower Lumbar Spine , 2014, Global spine journal.

[6]  Amit Jain,et al.  Three-Column Osteotomies in the Treatment of Spinal Deformity in Adult Patients 60 Years Old and Older: Outcome and Complications , 2013, Spine.

[7]  S. Kishida,et al.  Comparison of Teriparatide and Bisphosphonate Treatment to Reduce Pedicle Screw Loosening After Lumbar Spinal Fusion Surgery in Postmenopausal Women With Osteoporosis From a Bone Quality Perspective , 2013, Spine.

[8]  S. Kishida,et al.  Teriparatide Accelerates Lumbar Posterolateral Fusion in Women With Postmenopausal Osteoporosis: Prospective Study , 2012, Spine.

[9]  S. Lewis,et al.  Upper Instrumented Vertebral Fractures in Long Lumbar Fusions: What Are the Associated Risk Factors? , 2012, Spine.

[10]  S. Boriani,et al.  Fenestrated pedicle screws for cement-augmented purchase in patients with bone softening: a review of 21 cases , 2011, Journal of Orthopaedics and Traumatology.

[11]  H. Tsai,et al.  Pedicle screw loosening in dynamic stabilization: incidence, risk, and outcome in 126 patients. , 2011, Neurosurgical focus.

[12]  R. Kuroda,et al.  Intimate relationship between instability and degenerative signs at L4/5 segment examined by flexion–extension radiography , 2011, European Spine Journal.

[13]  T. Yoshimine,et al.  Radiculopathy caused by osteoporotic vertebral fractures in the lumbar spine. , 2011, Neurologia medico-chirurgica.

[14]  A. Patwardhan,et al.  Evaluation of pullout strength and failure mechanism of posterior instrumentation in normal and osteopenic thoracic vertebrae. , 2010, Journal of neurosurgery. Spine.

[15]  S. Ohtori,et al.  Subsequent Vertebral Fractures Following Spinal Fusion Surgery for Degenerative Lumbar Disease: A Mean Ten-Year Follow-up , 2010, Spine.

[16]  Terrence T. Kim,et al.  Successful Treatment of Thoracolumbar Fractures With Short-segment Pedicle Instrumentation , 2010, Journal of spinal disorders & techniques.

[17]  W. Hutton,et al.  Pedicle Screw Augmentation With Polyethylene Tape: A Biomechanical Study in the Osteoporotic Thoracolumbar Spine , 2010, Journal of spinal disorders & techniques.

[18]  A. Minami,et al.  One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits , 2010, European Spine Journal.

[19]  L. Lenke,et al.  Proximal Junctional Vertebral Fracture in Adults After Spinal Deformity Surgery Using Pedicle Screw Constructs: Analysis of Morphological Features , 2010, Spine.

[20]  M. Kurosaka,et al.  The Influence of Sagittal Instability Factors on Clinical Lumbar Spinal Symptoms , 2009, Journal of spinal disorders & techniques.

[21]  M. Beppu,et al.  An Experimental Study on Initial Fixation Strength in Transpedicular Screwing Augmented With Calcium Phosphate Cement , 2009, Spine.

[22]  U. Nalbantoğlu,et al.  The Use of Screw at the Fracture Level in the Treatment of Thoracolumbar Burst Fractures , 2009, Journal of spinal disorders & techniques.

[23]  M. Aebi,et al.  A comprehensive classification of thoracic and lumbar injuries , 2005, European Spine Journal.

[24]  Tomio Yamamoto,et al.  Clinical and Radiological Results of PLIF for Degenerative Spondylolisthesis , 1998 .