The Surgical Treatment of the Osteoporotic Vertebral Compression Fracture in the Elderly Patients with the Spinal Instrumentation
Chatupon Chotigavanich MD*, Sanyapong Sanpakit MD*, Thanet Wantthanaapisith MD*, Surin Thanapipatsiri MD*, Charoen Chotigavanich MD*
Affiliation : * Department of Orthopedic surgery, Faculty of Medicine Siriraj hospital, Mahidol University, Bangkok, Thailand
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
