Transpedicular Intravertebral Cage Augmentation in a Patient with Neurologic Deficits After Severely Collapsed Kummel Disease: Minimum 2-Year Follow-Up.

Abstract

We have reported the surgical outcomes of an anterior column support procedure, the intravertebral cage augmentation technique for the osteoporotic spine. A total of 10 consecutive osteoporotic patients with severely collapsed plana-type vertebrae, causing delayed neurologic deficits, were enrolled in cohort manner. They underwent intravertebral cage augmentation using a single posterior approach. The postoperative follow-up period was >2 years. The patients were divided into 2 groups: group I, fractured index vertebra at the thoracolumbar; and group II, fractured index vertebra at the lower lumbar. The radiographic analysis included the restored ratio of anterior vertebral height, local kyphotic angle, thoracolumbar kyphosis, and lumbar lordosis. The radiographic and clinical results, ambulatory status, and Oswestry disability index were evaluated. Compared with preoperatively, the average restored ratio of the anterior vertebral height was 2.98 and 2.35 times greater, and the local kyphotic angle had been corrected from an average of 20.3° and 14.8° to an average of 3.0° and 0.2° at the final follow-up visit in groups I and II, respectively. The thoracolumbar kyphosis in group I had been corrected from an average of 32.9° to 19.7° and the lumbar lordosis in group II had improved from an average of -15.8° to -32.3° at the final follow-up visit. All patients who could not independently ambulate preoperatively became able to walk, except for 2 patients who required a cane. Also, all the patients showed significant improvement in the Oswestry disability index (group I: average, from 38.2 to 12.8; group II, from 37.3 to 19.3). The introduced technique is a valuable surgical option for obtaining anterior column support in osteoporotic patients with severely collapsed Kummel disease who require decompression and stabilization procedures using only a posterior approach.