Surgical patterns in osteoporotic vertebral compression fractures

Abstract

Purpose: To report morphological patterns of osteoporotic vertebral compression fractures (OVCFs) presenting for surgery. To describe surgical options based on fracture pattern. To evaluate clinical and radiological outcome.

Methods: Forty consecutively operated OVCFs nonunion patients were retrospectively studied. We define four patterns of OVCFs that needed surgical intervention. Group 1 mini open vertebroplasty (N = 10) no neurologic deficits and kyphotic deformity, but with intravertebral instability and significant radiological spinal canal compromise. Group 2 with neurologic deficits (N = 24) (2A)-transpedicular decompression (TPD) with instrumentation (N = 14). Fracture morphology similar to (1) and localized kyphosis <30° (2B)-pedicle subtraction osteotomy (PSO) with instrumentation (N = 10). Fracture morphology similar to (1) and local kyphosis >30°. Group 3 posterolateral decompression with interbody reconstruction (N = 06) endplate(s) destroyed, with instability at discovertebral junction, with neurologic deficit. Average follow-up was 34 months. VAS, ODI and Cobb angle were recorded at 3, 6, 12 months and yearly.

Results: There was significant improvement in the clinical (VAS and ODI) scores and radiologic outcome in each group at last follow-up. 30 patients out of 40, had neurologic deficits (Frankel's grade C = 16, Frankel's grade D = 14). The motor power gradually improved to Frankel's grade E. Average duration of surgery was 97 min. Average blood loss was 610 ml.

Conclusion: Different surgical techniques were used to suit different fracture patterns, with good clinical and radiological results. This could be a step forward in devising an algorithm to surgical treatment of OVCF nonunions.

Fig. 1

Algorithm to surgical treatment of un-united osteoporotic VCFs

Fig. 2

Mini open VP

Fig. 3

Transpedicular decompression

Fig. 4

Pedicle subtraction osteotomy

Fig. 5

Posterolateral decompression and interbody cage reconstruction

Fig. 6

Preop MRI, intraop photo and postop X-ray of mini open vertebroplasty

Fig. 7

Preop MRI, IITV image and post op X-ray of transpedicular decompression and instrumentation

Fig. 8

Preop X-ray, MRI, intraop IITV image and photo of pedicle subtraction osteotomy with instrumentation

Fig. 9

Preop MRI, CT scan and postop X-ray of posterolateral decompression with interbody reconstruction and instrumentation