[Back pain and neurological deficits in osteoporotic spinal fractures]

Generally osteoporotic compression fractures of the spine cause only localized pain and kyphosis without other significant complications. These fractures usually heal without difficulty by conservative treatment. However, it becomes to be accepted as a general concept that a small number of patients with osteoporotic fracture of the thoracolumbar spine result in delayed vertebral body collapse with neural compromise. We analyzed our series of osteoporotic-posttraumatic vertebral collapse. We had treated 51 consecutive patients with posttraumatic vertebral collapse following osteoporotic compression fractures of the thoracolumbar spine between Jan. 1987 and June 1994. Surgery consisted of anterior spinal reconstruction by strut grafting using a bioactive ceramic vertebral prosthesis (A-WGC) and autogenous rib in combination with the Kaneda device after resecting the collapsed vertebral bodies. After surgery, 80% of the patients with initial neurological deficits showed remarkable neurological recovery. The causes of neural compression were retropulsion of the posterior part of the collapsed vertebral body into the spinal canal and unstable kyphosis. The collapsed portion of the resected vertebral bodies was always less bloody or ischemic. Histology confirmed ischemic necrosis of the collapsed portion. The collapse would be resulted in by the compromised healing process due to repeated micro-traumas to the fragile trabecular bone following osteoporotic vertebral fracture. Autogenous iliac bone as well as fibula cannot be used as another alternative strut graft because of the fragility of the graft and grafted site. The anterior reconstruction with a bioactive ceramic vertebral prosthesis and the Kaneda device has been useful in osteonecrotic-posttraumatic vertebral collapse of the thoracolumbar spine.