Skip to main content
Log in

Late collapse osteoporotic vertebral fracture in an elderly patient with neurological compromise

  • Grand Rounds
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Vertebral fracture is a frequent phenomenon in people with osteoporosis and does not lead to clinical problems in most cases. Only a small number of patients suffer from serious neurological complications related to late collapse. Acute or subacute painful osteoporotic vertebral fracture can be tackled using reinforcement techniques; however, neural compression by displaced bone fragments and late kyphosis can produce neurological deficit and require surgical decompression and stabilization. The identification of risk factors associated with a patient’s poor recovery is important for adequate treatment. In elderly patients, both the morbidity of the approach and the difficulty of stabilization are the main drawbacks. We present here a case study of an osteoporotic fracture in an elderly man with severe late collapse and neurological impairment. A posterior approach was used with bilateral posterior transpedicular decompression and instrumented arthrodesis with cemented pedicle screws. The post-operative period was incident-free and the patient recovered the neurological deficit and the ability to walk.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

References

  1. Lee YL, Yip KM (1996) The osteoporosis spine. Clin Orthop 323:91–97

    Article  PubMed  Google Scholar 

  2. Shikata J, Yamamuro T, Iida H, Shimizu K, Yoshikawa J (1990) Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis. Spine 15:485–489

    Article  CAS  PubMed  Google Scholar 

  3. Kempisky WH, Morgan PP, Boniface WR (1958) Osteoporosis kyphosis with paraplegia. Neurology 8:181–186

    Article  Google Scholar 

  4. Kaneda K, Asano S, Hashimoto T et al (1992) The treatment of osteoporotic posttraumatic vertebral collapse using the Kaneda device and bioactive ceramic vertebral prosthesis. Spine 17:295–303

    Article  Google Scholar 

  5. Genant HK, Wu CY, van Kuijk C et al (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148

    Article  CAS  PubMed  Google Scholar 

  6. Tsujio T, Nakamura H, Terai H et al (2011) Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion. Spine 36:1229–1235

    Article  PubMed  Google Scholar 

  7. Saita K, Hoshino Y, Kikkawa I, Nakamura H (2000) Posterior spinal shortening for paraplegia after vertebral collapse caused by osteoporosis. Spine 25:2832–2835

    Article  CAS  PubMed  Google Scholar 

  8. Sawakami K, Yamazaki A, Ishikawa S, Ito T, Watanabe K, Endo N (2012) Polymethylmethacrylate augmentation of pedicle screws increases the initial fixation in osteoporotic spine patients. J Spinal Disord Tech 25:E28–E35

    Google Scholar 

  9. Suk S, Kim JH, Lee SM, Chung ER, Lee JH (2003) Anterior-Posterior surgery versus posterior wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine 18:2170–2175

    Article  Google Scholar 

  10. Mochida J, Eiren T, Masahiro C, Kazuhiro N (2001) Treatment of osteoporotic late collapse of a vertebral body of thoracic and lumbar spine. J Spinal Disord 14(5):393–398

    Article  CAS  PubMed  Google Scholar 

  11. Sudo H, Ito M, Abumi K, Kotani Y, Takahata M, Hojo Y, Minami A (2010) One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. Eur Spine J 19(6):907–915

    Article  PubMed Central  PubMed  Google Scholar 

  12. Thawait Shrey K et al (2012) Research synthesis: what is the diagnostic performance of magnetic resonance imaging to discriminate benign from malignant vertebral compression fractures? Spine 37:E736–E744

    Article  PubMed  Google Scholar 

  13. Buchbinder R et al (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361:557–568

    Article  CAS  PubMed  Google Scholar 

  14. Rousing R (2012) Twelve-months follow-up in forty-nine patients with acute/semiacute osteoporotic vertebral fractures treated conservatively or with percutaneous vertebroplasty. Spine 35(478):482

    Google Scholar 

  15. McGirth MJ et al (2009) Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J 9:501–508

    Article  Google Scholar 

  16. Kallmes D et al (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361:559–569

    Article  Google Scholar 

  17. Li YA et al (2012) Subsequent vertebral fracture after vertebroplasty. Incidence and analysis of risk factors. Spine 37:179–183

    Article  CAS  PubMed  Google Scholar 

  18. Kyle RA, Rajkumar SV (2004) Multiple myeloma. N Engl J Med 351:1860–1873

    Article  CAS  PubMed  Google Scholar 

  19. Ayberk G, Ozveren MF, Altundal N et al (2008) Three column stabilization through posterior approach alone: transpedicular placement of distractable cage with transpedicular screw fixation. Neurol Med Chir (Tokyo) 48:8–14

    Article  Google Scholar 

  20. Metcalfe S, Gbejuade H, Patel N (2012) The posterior transpedicular approach for circumferential decompression and instrumented stabilization with titanium cage vertebrectomy reconstruction for spinal tumors. Spine 37:1375–1383

    Article  PubMed  Google Scholar 

  21. Yamana K, Tanaka M, Sugimoto Y, Takigawa T, Ozaki T, Konishi H (2010) Clinical application of a pedicle nail system with polymethyl methacrylate for osteoporotic vertebral fracture. Eur Spine J 19(10):1643–1650

    Article  PubMed Central  PubMed  Google Scholar 

  22. Sasane M, Özer AF (2008) Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fracture. Spine 34:E33–E40

    Article  Google Scholar 

  23. Disch AC, Schaser KD, Melcher I et al (2008) En bloc spondylectomy reconstructions in a biomechanical in vitro study. Eur Spine J 17:715–725

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Khodadadyan-Klostermann C, Schaefer J, Schleicher P et al (2004) Expandable cages: biomechanical comparison of different cages for ventral spondylodesis in the thoracolumbar spine. Chirurgia 75(7):694–701

    Article  CAS  Google Scholar 

Download references

Conflict of interest

None of the authors has any potential conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to D. Ruiz Picazo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Picazo, D.R., Villaescusa, J.R., Martínez, E.P. et al. Late collapse osteoporotic vertebral fracture in an elderly patient with neurological compromise. Eur Spine J 23, 2696–2702 (2014). https://doi.org/10.1007/s00586-013-2751-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-013-2751-3

Keywords

Navigation