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DELAYED‐ONSET PARALYSIS AND ITS ANATOMIC CAUSE FOLLOWING OSTEOPOROTIC VERTEBRAL FRACTURE: GP187.

Otani, Koji; Kikuchi, Shin‐ichi; Konno, Shin‐ichi; Sato, Katsuhiko; Iwabuchi, Masumi

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Spine Journal Meeting Abstracts: October 2010 - Volume - Issue - p 329
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INTRODUCTION: Delayed‐onset paralysis following osteoporotic vertebral fracture has been well recognized. It is generally believed that most of cases are caused by burst fracture. However, carefully following cases, some cases showed delayed‐onset paralysis without middle column injury. The purpose of this study was to clarify the anatomic cause of delayed‐onset paralysis following osteoporotic vertebral fracture.

METHODS: Forty‐six patients (male 9, female 37) were assessed. The average age was 70yo. Paralysis was divided for three types; myelopathy (31cases), cauda equina type (2 cases) and radiculopathy (13 cases). Cause of paralysis was considered by image findings including lateral position of roentgenogram (flexion, extension, neutral), CT, MRI and operative findings if operation was performed.

RESULTS: Cause of paralysis was mainly divided four types, burst fracture type (28 cases), wedge type (8 cases), flat type (4 cases), hypermobility type (3cases), and others (3 cases). Burst fracture type was judged as vertebral collapse and severe middle column injury. This type showed that neural tissue was compressed by posterior wall of vertebra. Wedge type was judged as no or minimum middle column injury and relatively stable fractured vertebra. This type showed that neural tissue was compressed by both posterior edge of fractured vertebra and posterior elements (flavum and/or facet joint) (Kaji, 1998). Flat type was judged as vertebral collapse but minimum middle column injury. This type showed that neural tissue was compressed by buckling of flavum and facet joint similar to degenerative spinal canal stenosis. Hypermobility type was judged as no or minimum middle column injury and severe unstable fractured vertebra. This type showed that MRI could not detect neural tissue compression.

DISCUSSION: There are several types of the anatomic cause of delayed‐onset paralysis following osteoporotic vertebral fracture. It seems to be important to assess the anatomic cause for choice of operation procedure.

© 2010 Lippincott Williams & Wilkins, Inc.