J Med Assoc Thai 2009; 92 (9):109

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The Surgical Treatment of the Osteoporotic Vertebral Compression Fracture in the Elderly Patients with the Spinal Instrumentation
Chotigavanich C Mail, Sanpakit S , Wantthanaapisith T , Thanapipatsiri S , Chotigavanich C

The study was to present the results of the surgical treatment using the spinal instrumentation toe
resolve the osteoporotic vertebral compression fracture in the elderly patients having the clinical symptoms of
pain and the neurological compromise.

Sixty elderly patients who underwent the surgical treatment of the osteoporotic vertebral compression
fracture were retrospectively reviewed. Their average age was 72 years; the range was 60-90. The average
follow-up period for these patients was 4.2 years; the range was 3-7. Twenty-four patients were performed by
the posterior stabilization enhanced by the pedicle screws and rods with the transpedicular bone grafting.
Thirty-two patients were performed by the anterior corpectomy with the interbody fusion and the anterior
spinal instrumentation. Four patients were performed by two-step surgical treatment: firstly the posterior
stabilization enhanced by pedicle screws and rods, and finally, the anterior corpectomy with the interbody
fusion.

The sagittal Cobb angle and the back pain were improved in all patients. The neurological deficits
were improved in 14 patients out of the 16 patients. Twelve patients had the post operative complications: late
implants loosening in 5 patients, subcutaneous wound infections in 4 patients, painful neuromas at thoracic
cage in 2 patients and incisional hernia in one patient.

Although the surgical treatment with spinal implants in the osteoporotic compression fracture was
performed in the selected patients, the complication rate was still high, i.e. twenty percent. All of them,
nevertheless, were not the mortal complications. The anterior column support could maintain the sagittal
alignment better than the posterior spinal fusion alone in the long-term follow up period while the VAS of pain
was improved in the similar results.

Keywords: Bone screws, Complications, Fractures, compression, Instrumentation, Lumbar vertebrae,
Osteoporosis, Neurosurgical procedures, Orthopedic fixation devices, Spinal fractures

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