Conus Medullaris Syndrome Secondary to an L1 Burst Fracture in Osteoporosis

Tanaka, Shin; Kubota, Masaomi; Fujimoto, Yoshinori; Hayashi, Junji; Nishikawa, Kouichirou

doi:10.1097/00007632-199310001-00034

Cited by 38 publications

(27 citation statements)

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“…In accordance with this theory, several types of surgical decompression and fusion through either an anterior and/or posterior approach have been performed [1,12,15,19,26,31,34,37]. However, some authors have reported that conservative treatment could provide reliable neurologic improvement.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit

et al. 2013

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Introduction The number of cases of osteoporotic vertebral compression fracture (OVCF) with intravertebral cleft (IVC) with delayed neurologic deficit (DND) is increasing as the population ages. However, the cause of DND is poorly understood, and no definitive treatment of the disease has been established. The purpose of this study was to clarify the radiographic parameters contributing to the occurrence of DND, and to evaluate the efficacy and safety of percutaneous vertebroplasty for this pathology. Methods Percutaneous vertebroplasty was prospectively performed for 244 patients with OVCF with IVC; 30 had DND and 214 did not. Radiographic parameters of local kyphotic angle, percent spinal canal compromise and intravertebral instability were investigated for correlations to DND. Procedural outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Frankel grades. Results Before vertebroplasty, no substantial difference in local kyphotic angle was seen between OVCF with IVC with and without DND, but percent spinal canal compromise and intravertebral instability were greater in OVCF with IVC with DND (P \ 0.001). After vertebroplasty, 25 of 30 cases (84 %) of OVCF with IVC with DND achieved clinically meaningful improvement (CMI), but 5 (17 %) did not. Patients with CMI showed substantial improvements in intravertebral instability (P \ 0.001), and no change in local kyphotic angle or percent spinal canal compromise. In five patients without CMI, four showed an initial improvement, but subsequent vertebral fracture adjacent to the treated vertebra caused neurologic re-deterioration. One patient with percent spinal canal compromise 54.9 % and intravertebral instability 4°achieved no neurologic improvement following vertebroplasty. No serious complications or adverse events related to the procedure were encountered. ConclusionsIntravertebral instability is the dominant cause of DND. Percutaneous vertebroplasty appears effective and safe in the treatment of OVCF with IVC with DND. Patients with less intravertebral instability and severe spinal canal compromise could be candidates for conventional surgical treatment.

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Section: Discussionmentioning

confidence: 99%

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit

et al. 2013

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“…After exclusion of case reports on just 1-4 patients and conference abstracts [24][25][26][27][28][29][30][31][32][33][34][35], studies in the English literature on surgical treatment of stage III Ku¨mmell's disease [9-11, 14, 36-38] have been summarized in Table 4. Operations using various fixation methods and body reconstruction tended to improve neurological defects.…”

Section: Discussionmentioning

confidence: 99%

Another option to treat Kümmell’s disease with cord compression

Hsieh

et al. 2006

Eur Spine J

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“…Previous reports have shown that incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine are caused by neural compression due to retropulsed bone fragments in the spinal canal, progression of kyphosis, and instability at the fracture site [1,4,7,13,17,18]. Of the several types of surgical procedures reported for the treatment of this condition, most have emphasized the importance of decompressing the spinal cord and/or cauda equina through either an anterior or posterior approach [4,7,8,[13][14][15][16]19].…”

Section: Introductionmentioning

confidence: 99%

Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine

2008

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Previous reports have emphasized the importance of neural decompression through either an anterior or posterior approach when reconstruction surgery is performed for neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. However, the contribution of these decompression procedures to neurological recovery has not been fully established. In the present study, we investigated 14 consecutive patients who had incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine and underwent posterior instrumented fusion without neural decompression. They were radiographically and neurologically assessed during an average follow-up period of 25 months. The mean local kyphosis angle was 14.6°at flexion and 4.1°at extension preoperatively, indicating marked instability at the collapsed vertebrae. The mean spinal canal occupation by bone fragments was 21%. After surgery, solid bony fusion was obtained in all patients. The mean local kyphosis angle became 5.8°immediately after surgery and 9.9°at the final follow-up. There was no implant dislodgement, and no additional surgery was required. In all patients, back pain was relieved, and neurological improvement was obtained by at least one modified Frankel grade. The present series demonstrate that the posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine can provide neurological improvement and relief of back pain without major complications. We suggest that neural decompression is not essential for the treatment of neurological impairment due to osteoporotic vertebral collapse with dynamic mobility.

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Conus Medullaris Syndrome Secondary to an L1 Burst Fracture in Osteoporosis

Cited by 38 publications

References 0 publications

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit

Another option to treat Kümmell’s disease with cord compression

Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine

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