Transpedicular Wedge Osteotomy for Osteoporotic Vertebral Fracture with Neurological Compromise

Osteoporotic vertebral fractures are common in the elderly and most can be managed nonsurgically. Neurocompression, acute or delayed onset, may arise from neural canal encroachment or progression of kyphosis. Surgical treatment for this specific condition is indicated but the approach remains controversial. The purpose of our study is to analyze the clinical and radiographic outcomes of patients undergoing transpedicular wedge osteotomy and posterior fusion with instrumentation. Between 1998 and 2002, we surgically treated 12 patients with osteoporotic spine fracture complicated by neurological deficit and kyphosis deformity. The procedure involved wide laminectomy, removal of canal-encroaching fracture fragment via a bilateral transpedicular approach, shortening of the vertebral column, and posterior instrumentation with posterior fusion. The mean follow-up was 2.2 years. The mean kyphosis improved from 33.6° preoperatively to 12.5° postoperatively and was maintained at 15.3° at the latest follow-up. Neurological improvement, pain relief, kyphosis correction, and solid fusion were achieved in most patients. Complications included deep wound infection in two patients and loss of fixation in two patients. In conclusion, transpedicular wedge osteotomy combined with posterior fusion instrumentation can provide safe and effective neural decompression, deformity correction, and fracture stabilization in patients who have osteoporotic vertebral fracture with neurological compromise.

並列關鍵字

osteoporotic vertebral fracture ； transpedicular wedge osteotomy

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