[Osteoporotic vertebral crush fractures with severe neurologic manifestations. Apropos of 6 cases].
Osteoporotic vertebral crush fractures with neurologic complications are rarely reported in the literature. We report six new cases particularly severe in which death occurred in two cases. The study group included four women and two men with a mean age of 75 years (range: 72-79). Vertebral collapse causing neurological deficit was T5, T9, T11 in two cases, L1 and L3. The mean number of vertebral collapses was three per patient (range: 1-9). Back pain appeared without traumatism 6 weeks before admission (range: 1-24). Neurological complications appeared 2.5 weeks after back pain (range: 1-8). One patient suffered from a paraplegia, three from a paraparesia with bladder dysfunction (n = 1). In one case there was a severe weakness of the levator muscles of the foot and in another a L3 femoral neuralgia with severe bowel and bladder dysfunction. X-rays demonstrated backwards displacement of the posterior cortex in three cases, an intravertebral vacuum phenomenon in two cases and a heterogeneous appearance suggesting a malignancy in two cases. Computed tomography, performed in four patients and tomography in one patient, demonstrated fragmentation of the vertebral body in all the cases and vacuum phenomenon in four cases. Magnetic resonance imaging performed in four cases has confirmed the absence of epiduritis and a compression due to bony structures in two cases. A vertebral biopsy was performed in three cases. Osteoporosis was observed in all the cases and in two cases there was also an osteonecrosis. Surgical treatment was performed in three cases and conservative medical treatment in the other cases. After surgical treatment we have observed an absence of improvement of neurological complications in one case, an improvement in another and finally a full recovery in the last case. After conservative treatment we have noted in two cases an absence of improvement of neurological complications and in one case an improvement of neurological deficit. Two patients died (one after medical treatment and another after surgical treatment).
Cortet
B
B
Service de rhumatologie, CHU de Lille, France.
Solau-Gervais
E
E
Labbe
P
P
Cotten
A
A
Flipo
R M
RM
Duquesnoy
B
B
Houvenagel
E
E
Delcambre
B
B
D000368:Aged; D005260:Female; D005598:Fractures, Spontaneous; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D010024:Osteoporosis / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D013122:Spinal Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy
Tassements vertébraux ostéoporotiques avec complications neurologiques sévères. A propos de six observations.