Osteoporotic kyphosis with paraplegia

Kempinsky, Warren H.; Morgan, Peter; Boniface, William R.

doi:10.1212/wnl.8.3.181

Cited by 83 publications

(31 citation statements)

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“…The concern with decompression alone, such as laminectomy, is the progression of the kyphotic deformity, which leads to further complications [15]. Decompression can be approached either anteriorly or posteriorly.…”

Section: Diagnostic Imagingmentioning

confidence: 99%

Kummell’s disease: delayed post-traumatic osteonecrosis of the vertebral body

Chow

Shen

2009

Eur Spine J

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Section: Diagnostic Imagingmentioning

confidence: 99%

Kummell’s disease: delayed post-traumatic osteonecrosis of the vertebral body

Chow

Shen

2009

Eur Spine J

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“…Neurological deficit can range from acute paraplegia (usually after an acute crush fracture) [98,102] to delayed onset of insidious paralysis that gradually deteriorates to severe paraplegia [69,73]. The latter phenomenon is usually associated with delayed vertebral collapse and progressive kyphotic deformity [75].…”

Section: Discussionmentioning

confidence: 99%

“…The only technical complication reported with this approach is dural tear (14%) [75]. Laminectomy, as a standalone procedure, should be rejected, because it does not deal with the anterior cord compression, and further deterioration of neurological deficit from progressive kyphotic deformity has been observed [73]. …”

Section: Surgical Approachmentioning

confidence: 99%

Principles of management of osteometabolic disorders affecting the aging spine

Hadjipavlou

Katonis

Tzermiadianos

et al. 2003

European Spine Journal

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Osteoporosis is the most common contributing factor of spinal fractures, which characteristically are not generally known to produce spinal cord compression symptoms. Recently, an increasing number of medical reports have implicated osteoporotic fractures as a cause of serious neurological deficit and painful disabling spinal deformities. This has been corroborated by the present authors as well. These complications are only amenable to surgical management, requiring instrumentation. Instrumenting an osteoporotic spine, although a challenging task, can be accomplished if certain guidelines for surgical techniques are respected. Neurological deficits respond equally well to an anterior or posterior decompression, provided this is coupled with multisegmental fixation of the construct. With the steady increase in the elderly population, it is anticipated that the spine surgeon will face serious complications of osteoporotic spines more frequently. With regard to surgery, however, excellent correction of deformities can be achieved, by combining anterior and posterior approaches. Paget's disease of bone (PD) is a non-hormonal osteometabolic disorder and the spine is the second most commonly affected site. About one-third of patients with spinal involvement exhibit symptoms of clinical stenosis. In only 12-24% of patients with PD of the spine is back pain attributed solely to PD, while in the majority of patients, back pain is either arthritic in nature or a combination of a pagetic process and coexisting arthritis. In this context, one must be certain before attributing low back pain to PD exclusively, and antipagetic medical treatment alone may be ineffective. Neural element dysfunction may be attributed to compressive myelopathy by pagetic bone overgrowth, pagetic intraspinal soft tissue overgrowth, ossification of epidural fat, platybasia, spontaneous bleeding, sarcomatous degeneration and vertebral fracture or subluxation. Neural dysfunction can also result from spinal ischemia when blood is diverted by the so-called "arterial steal syndrome". Because the effectiveness of pharmacologic treatment for pagetic spinal stenosis has been clearly demonstrated, surgical decompression should only be instituted after failure of antipagetic medical treatment. Surgery is indicated as a primary treatment when neural compression is secondary to pathologic fractures, dislocations, spontaneous epidural hematoma, syringomyelia, platybasia, or sarcomatous transformation. Five classes of drugs are available for the treatment of PD. Bisphosphonates are the most popular antipagetic drug and several forms have been investigated. Keywords

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“…This pathology has relatively recently become widely known. In 1958, Kempinsky et al 4 reported two surgical cases. However, the pathology was not widely known and was only actively reported [5][6][7][8] after it was reported by Maruo et al in 1987.…”

Section: Introductionmentioning

confidence: 99%

“…However, this surgery is highly invasive for the extreme elderly, so prevention of perioperative and postoperative complications and a good prognosis are sought. In Kempinsky's 4 cases, however, laminectomy was performed, although there was no effective improvement. Afterwards, improvement by laminectomy with spinal fusion surgery using instrumentation has been reported.…”

Section: Introductionmentioning

confidence: 99%

Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis

et al. 2007

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Study design: Retrospective case series. Objectives: To assess the efficacy of posterior spinal shortening for paraparetic patients following vertebral collapse owing to osteoporosis, especially on instrumentation loosening. Setting: Department of orthopaedic surgery, Jichi Medical University Hospital and Omiya Medical Center in Japan. Methods:The clinical records and radiographs of 13 patients with paraparesis following vertebral collapse owing to osteoporosis treated with posterior spinal shortening were retrospectively reviewed to evaluate the usefulness of this method. Assessment of the clinical course was done by direct examination in all cases. Ambulatory ability was divided into four categories. Results: Upon final observation, nine cases were able to walk with a cane or crutch, one case remained in gait training, two cases remained unable to stand and one case with urinary incontinence improved in urinary function. In one case, paralysis deteriorated. Vertebral compression fracture of the end vertebrae that were fixed occurred in three cases complicated with rheumatoid arthritis. Conclusion: The posterior spinal shortening can be a choice for treating delayed paraparesis following vertebral collapse owing to osteoporosis.

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Osteoporotic kyphosis with paraplegia

Cited by 83 publications

References 0 publications

Kummell’s disease: delayed post-traumatic osteonecrosis of the vertebral body

Kummell’s disease: delayed post-traumatic osteonecrosis of the vertebral body

Principles of management of osteometabolic disorders affecting the aging spine

Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis

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