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Case Reports
. 2016 Jul 28:12:1145-50.
doi: 10.2147/TCRM.S112656. eCollection 2016.

Repeated adjacent segment diseases and fractures in osteoporotic patients: a case report

Hsin-Yao Chen  1 , Chiu-Liang Chen  2 , Wei-Liang Chen  3
Affiliations
Case Reports

Repeated adjacent segment diseases and fractures in osteoporotic patients: a case report

Hsin-Yao Chen et al. Ther Clin Risk Manag. .

Abstract

Background: Pedicle screw instrumentation for treating spinal disorder is becoming increasingly widespread. Many studies have advocated its use to facilitate rigid fixation for spine; however, adjacent segmental disease is a known complication. Instrumented fusion for osteoporotic spines remains a significant challenge for spine surgeons. Prophylactic vertebroplasty for adjacent vertebra has been reported to reduce the complications of junctional compression fractures but has raised a new problem of vertebral subluxation. This case report is a rare and an extreme example with many surgical complications caused by repeated instrumented fusion for osteoporotic spine in a single patient. This patient had various complications including adjacent segmental disease, vertebral subluxation, and junctional fractures on radiographs and magnetic resonance images.

Case presentation: An 81-year-old Taiwanese woman underwent decompression and instrumented fusion of L4-L5 in Taiwan 10 years ago. Due to degenerative spinal stenosis of L3-L4 and L2-L3, she had decompression with instrumented fusion from L5 to L1 at the previous hospital. However, catastrophic vertebral subluxations with severe neurologic compromise occurred, and she underwent salvage surgeries twice with prolonged instrumented fusion from L5 to T2. The surgeries did not resolve her problems of spinal instability and neurologic complications. Eventually, the patient remained with a Frankel Grade C spinal cord injury.

Conclusion: Adjacent segmental disease, junctional fracture, and vertebral subluxation are familiar complications following instrumented spinal fusion surgeries for osteoporotic spines. Neurologic injuries following long instrumentation are often serious and difficult to address with surgery alone. Conservative treatments should always be contemplated as an alternative method for patients with poor bone stock.

Keywords: complication; instrumented fusion; junctional fracture; osteoporotic spine; vertebral subluxation.

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Figures

Figure 1
Figure 1
(A and B) Standing radiographs (anteroposterior and lateral view) showing degenerative disc change with retrolisthesis of L2-L3 and L3-L4; (C) the first immediately postoperative radiograph after instrumented fusion from L1 to L5 with cement augmentation of T12 and L1.
Figure 2
Figure 2
Seven weeks after the first surgery. Notes: (A) Lateral view radiograph demonstrating subluxation of T12 with proximal junctional angle of 52° (T11-L1). (B) Computed tomography scan of spine showing T12 subluxation. (C) The second immediately postoperative radiograph 15 weeks after the previous surgery with spinal instrumentation from T9 to L5 with cement augmentation of T8 and T9.
Figure 3
Figure 3
(A) Lateral radiograph demonstrating vertebral subluxation of T8 with proximal junctional angle of 36° (T7-T9) 19 days after previous surgery; (B) magnetic resonance image showing T8 subluxation with severe cord compression; (C) the third immediately postoperative radiograph. Note: The patient underwent extensive instrumented fusion from T2 to L5.
Figure 4
Figure 4
(A and B) The final whole spine radiographs; (C) magnetic resonance image showing fracture subluxation of T1 with proximal junctional angle of 28° (C7-T2) and severe cord compression 5 weeks after previous surgery.
See this image and copyright information in PMC

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