抄録
Objective. Various types of spinal reconstructive surgery have been performed for osteoporotic vertebral fracture associated with delayed neurological deficit (DND). However, patients with this spinal disorder are often older and have multiple medical comorbidities. Major/minor perioperative complications can sometimes be problematic. We analyzed the pathogenesis and mechanism of DND, and investigated the usefulness of percutaneous vertebroplasty (PVP) for osteoporotic vertebral fractures associated with DND.
Methods. Sixteen patients (average age 76 years ; range 61-91 years) with DND underwent PVP with polymethyl methacrylate. To investigate the pathogenesis and mechanism of DND, local kyphotic angle, vertebral instability, and rate of involvement of the posterior wall of the pseudoarthrotic vertebral bodies were assessed. As a control, the same parameters were studied in patients without DND who underwent PVP, and the results were compared with the DND group. The average follow-up period was 29 months (range 6-63 months). PVP outcome was evaluated using the modified Frankel classification and visual analogue scale (VAS).
Results. Fourteen patients showed one grade of neurological recovery on the modified Frankel classification upon discharge from hospital (mean 16.7 days after PVP), and their gait ability had improved to D2 grade at the final follow-up. Average kyphosis angle was corrected from 21.7 to 11.2 degrees (p<0.0001), and vertebral instability was also improved from 12.5 to 4.1 degrees (p<0.0015).
Conclusions. The main cause of DND is kyphotic deformity and vertebral instability. PVP improves kyphotic deformity and vertebral instability, and is a useful, less invasive surgical procedure for osteoporotic vertebral fracture associated with DND in the elderly.
