強直性脊椎障害・高度な骨粗鬆症を伴った脊椎骨折の1例

抄録

We report a case of lumbar vertebral fracture with severe osteoporosis due to ankylosing spinal disorder (ASD) in a 79-year-old woman who fell on her behind and was hospitalized for low back pain with first lumbar vertebral fracture (L1 fx.). She was transferred to our hospital for detailed investigation of the fracture after twelve days of conservative therapy. X-ray and CT images showed L1 fx. with ossification of the anterior longitudinal ligament at the level of the first thoracic vertebra to the fifth lumbar vertebra. Disc heights at each level between the vertebrae were maintained. Her bone mineral density was only 36% of the young adult mean. We concluded that the L1 fx. had occurred due to ASD with severe osteoporosis. After fifteen days of hospitalization for observation, an operation was performed for firm fixation with instrumentation and fiber cables from the eighth thoracic vertebra to the fifth lumbar vertebra (five above and four below fixation to L1 fx.). The patient was kept in bed for rest for four weeks after surgery so that the soft tissue in the operated region could heal. Rehabilitation was started with a tilting table for standing five weeks after the operation. Rehabilitation was suspended at six weeks because the patient suffered shortness of breath with pleural effusion, but it was re-started at nine weeks after three weeks of pleural effusion therapy in intensive care. She was able to walk at twelve weeks after the operation without any paralysis and was then transferred to another hospital for further rehabilitation. In cases of ASD, it is necessary to achieve firm fixation with instrumentation for vertebral fx. due to osteoporosis. This case of ASD showed the importance of long fusion fixation with instrumentation and fiber cables to maintain the posture of a patient with severe osteoporosis and to avoid instrumentation failure.