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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(04): 1207-1213
DOI: 10.4103/ajns.AJNS_95_19
Original Article

Clinico-radiological efficacy of posterior instrumentation, decompression, and transpedicular bone grafting in osteoporotic burst fracture associated with neurological deficit

Gaurav Mehta
0   Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra
,
Ankit Patel
0   Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra
,
Sanyam Jain
0   Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra
,
Zahir Merchant
0   Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra
,
Vishal Kundnani
0   Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra
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Objective: The aim of this study is to evaluate clinico-radiological outcomes of posterior surgery (decompression + instrumentation + transpedicular bone graft) in osteoporotic burst fracture associated with neurological deficit [OFND]. Materials and Methods: Forty patients with neurological deficit due to delayed osteoporotic vertebral collapse managed by posterior surgery (decompression + instrumentation + transpedicular bone graft) with minimum 2 years follow-up were included in the study. Approval from the Institutional Review Board was taken. Demographic data (age, sex, mode of injury, and the severity of osteoporosis); clinical parameters (Visual Analog Score [VAS], Oswestry Disability Index [ODI], Frankel grade), radiological parameters (local kyphosis), and surgical variables (blood loss, surgery duration, and intraoperative events) were recorded. Neurological worsening/improvement, complications, and implant failures were noted. Results: Significant improvement was noted in VAS (preoperative 8.20 ± 0.65/postoperative 4.1 ± 0.64) and ODI (preoperative 76.54 ± 6.96/postoperative 30.5 ± 6.56). Complete neurological recovery was noted in 37 patients (Frankel Grade E), three patients remained nonambulatory (Frankel Grade C). Significant improvement was noted in local kyphosis angle (preoperative = 21.80 ± 2.70; postoperative 11.40 ± 1.80), with 10% loss of correction (2.5 ± 0.90) at final follow-up. Symptomatic implant failure was noted in two patients and proximal junctional failure in one patient requiring an extension of fixation. Conclusions: OFND can be managed with a single posterior-only surgery with significant improvement in neurology and functional scores of patients. Aggressive kyphosis correction is often not required and optimal correction of kyphosis is noticed due to prone-positioning alone. Transpedicular grafting is safe and simple alternative to cement augmentation or anterior surgery for collapsed vertebrae.

Key-words:

Kyphosis - neurological deficit - ossteoporotic burst fracture - posterior surgery - surgical outcomes - transpedicular bone-graft

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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