Surgical treatment of a patient with failed ventral fixation of an old Th12 fracture affected by severe osteoporosis (case report)

• Published in: Geniĭ ortopedii = Genij ortopedii Vol. 29; no. 1; pp. 85 - 91
• Main Authors: Shulga, A.E., Ostrovskii, V.V., Zaretskov, V.V., Bazhanov, S.P., Likhachev, S.V., Smolkin, A.A.
• Format: Journal Article
• Language: English
• Published: Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics 01.02.2023
• Subjects: injury; osteoporosis; revision surgery; surgical management; thoracic and lumbar spine; ventral fixation
• ISSN: 1028-4427; 2542-131X
• DOI: 10.18019/1028-4427-2023-29-1-85-91

Osteoporotic vertebral compression fractures (OVCF) are common fragility fractures of the spine that can lead to the functional failure and neurological deficit in 15-35 % of cases. There is no clear understanding of preferred surgical techniques to be used for treatment of patients with complicated thoracic and lumbar OVCF. The objective was to analyze reasons of failed ventral intervention in a patient with old Th12 injury affected by osteoporosis and demonstrate a short- and long-term outcome of repeated surgery. Material and methods A 63-year-old patient underwent stabilization of the thoracolumbar spine using a combined polysegmental (screws/hooks) dorsal system with screws augmented with bone cement. Results Physical examination and radiography at 12 months showed no loss of correction or signs of structural instability. Bone-metal fusion was observed at the level of the mesh endofixator (Th11-L1). VAS scored 0-1 (standing = lying), the Oswestry Disability Index was 12 %. Discussion The poor outcome of ventral intervention was caused by inadequate instrumentation of the transitional thoracolumbar spine in osteoporotic patient leading to L1 destruction and gradual kyphotization of the stabilized spine. The satisfactory short- and long-term outcomes of the revision dorsal intervention indicated the effective surgical strategy in the case. Conclusion With the results of the case reported, the reliability of anterior fixation is to be considered in osteoporotic patients to determine the feasibility of extended ventral systems in elderly patients. Dorsal stabilization and spinal fusion without preliminary abdominal revision are practical with unstable anterior fixation being not accompanied by significant secondary spinal deformity.