Correction of osteoporotic fracture deformities with global sagittal imbalance.
Osteoporotic spinal deformities with global sagittal imbalance have devastating effects on patients. However, treatment is difficult and there is a high risk of perioperative medical and mechanical complications. Patients with osteoporotic spinal deformities are not ideal candidates for posterior pedicle subtraction osteotomy; the condition necessitates combined anterior-posterior for corrections of the deformity. We ascertained the complication rates and efficacy of the anterior-posterior surgery and determined the factors influencing the results. To determine complication rates we analyzed a series of patients (n = 32). To evaluate overall results, we analyzed 18 patients with more than 2-years followup. A total of 18 complications occurred in 12 of 32 patients (37.5%) with seven early complications occurring in five patients and 11 delayed complications occurring in seven patients. Three patients needed additional surgery to treat the complications. At 2 years postoperatively, 17 of 18 patients (94%) reported subjective improvement with 54% decrement of Oswestry Disability Index and 70% decrement of the visual analogue scale pain score. The factors associated with clinical improvement was restoration of total lumbopelvic lordosis, C7 plumb, and control of T4-12 thoracic kyphosis. Prevention and aggressive treatment of junctional fractures were important in achieving favorable results.


METHODS
Therapeutic study, Level IV (case series, [patients treated one way with no comparison group of patients treated in another way]). See the Guidelines for Authors for a complete description of the levels of evidence.
Kim
Won Joong
WJ
Department of Ortho-Neuro-Reconstructive Surgery, Synergy Spine Center, Seoul, Korea. frangiewjk@yahoo.co.kr
Lee
Eun-Suk
ES
Jeon
Sang Hyoeb
SH
Yalug
Irem
I
D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D008141:Lordosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000175:diagnosis; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome