골다공증성 압박 골절 후 발생하는 지연성 척추 붕괴: 위험인자 및 치료 계획 = Delayed Vertebral Collapse in Osteoporotic Vertebral Compression Fractures: Risk Factors and Treatment Strategies

다국어 초록 (Multilingual Abstract)

Study Design: Literature review.
Objectives: To review the complications of osteoporotic vertebral compression fractures (OCFs) with regard to risk factors and treatment strategies.
Summary of Literature Review: Understanding the complications and treatment methods of OCFs is important given their increasing prevalence.
Materials and Methods: Review of the literature.
Results: The complications of OCFs include kyphotic deformity due to a delayed collapse of the vertebral body and neurologic deficits. The pathophysiologic mechanism of these complications has not been established; however, the most accepted theory is posttraumatic avascular necrosis of the vertebral body. The risk factors for these complications include fracture at the thoracolumbar junction, systemic usage of steroids, severe osteoporosis, and radiological intravertebral vacuum cleft. Most of these complications require surgical treatment, the indications for which include progressing axial back pain, pseudarthrosis, kyphotic deformity, and neurologic deficits. Surgical approaches for treating the complications of OCFs include anterior, posterior, and combined anteriorposterior approaches. Osteotomies should be done when deformity correction is needed. The decision among these various surgical methods should be made considering patient factors and the surgeon’s ability to achieve the best outcomes with solid fusion.
Conclusions: The complications of OCFs include kyphotic deformity due to delayed collapse of the vertebral body and neurologic deficits. Most of these complications require surgical treatment, in which achieving solid fusion at the fracture site is the ultimate goal.
Patient-related factors and the surgeon’s ability should be considered prior to making decisions regarding surgery.

국문 초록 (Abstract)

연구 계획: 종설목적: 골다공증성 척추 압박 골절의 합병증의 위험 인자와 치료 방법에 대한 논의를 위함선행문헌의 요약: 골다공증성 척추 압박 골절의 유병률은 증가하는 추세로 이에 대한 합병증 및 치료 방법에 대한 이해가 중요하다.
대상 및 방법: 선행 논문 정리결과: 골다공증성 척추 압박 골절의 합병증으로 지연성 붕괴로 인한 척추의 후만 변형 및 신경학적 증상이 있고, 대게의 경우 보존적 치료 보다는 수술적인 치료가 필요하다. 골다공증성 척추 압박 골절의 합병증으로 후외상성 지연성 붕괴에 대한 명확한 원인은 밝혀 지고 있지 않지만 무혈성 괴사로 인한 원인이 가장 중요한 가설로 받아들여지고 있으며 이에 대한 위험 인자로 흉요추부의 골절, 스테로이드 사용, 골밀도 감소의 정도, 척추체내 공기 음영의 발생 등이 제시 된다. 수술적인 치료의 적응증으로 진행하는 축성 통증, 가관절증, 후만 변형, 신경학적 증상 등이 있으며 도달 방법으로는 전방 도달, 후방 도달 및 전후방 도달법을 사용하며 후만증의 교정을 위해서 절골술을 시행 할 수 있으며 수술 시 골유합의 성공 여부가 중요하다. 따라서 여러 수술 방법 중 환자의 전신적 건강상태와 술자의 숙련도, 골다공증성 척추 압박 골에 대한 기기 고정과 유합술에 제한점을 고려한 선택이 필요하겠다.
결론: 골다공증성 척추압박 골절의 합병증으로는 지연성 척추체 붕괴로 인한 후만 변형 및 신경학적 증상이 있다. 이에 대한 병태생리학적 기전과 위험인자에 대한 이해는 중요하다. 대게 발생한 합병증에 대해서는 수술적인 치료를 요하고, 이러한 수술적 치료의 가장 주된 목적은 골절 부위에서의 골유합을 얻는 것이다. 수술적 치료를 시행 전에 환자의 전신적인 건강 상태와 술자의 숙련도에 대한 고려가 있어야겠다.


약칭 제목: 골다공증성 척추 압박 골절의 합병증.

참고문헌 (Reference)

1 Gertzbein SD, "Wedge osteotomy for the correction of post-traumatic kyphosis. A new technique and a report of three cases" 17 : 374-379, 1992

2 Kanchiku T, "Usefulness of an early MRI-based classification system for predicting vertebral collapse and pseudoarthrosis after osteoporotic vertebral fractures" 27 : E61-E65, 2014

3 Kaneda K, "The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis" 17 (17): 295-303, 1992

4 Royle ND, "The operative removal of an accessory vertebra" 1 : 467-, 1928

5 Kumpan W, "The intravertebral vacuum phenomenon" 15 : 444-447, 1986

6 Maldague BE, "The intravertebral vacuum cleft : a sign of ischemic vertebral collapse" 129 : 23-29, 1978

7 Capener N, "The evolution of lateral rhachotomy" 36 : 173-179, 1954

8 Shikata J, "Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis" 15 : 485-489, 1990

9 Roberson JR, "Surgical reconstruction of late post-traumatic thoracolumbar kyphosis" 10 : 307-312, 1985

10 Okuda S, "Surgical outcomes of posterior lumbar interbody fusion in elderly patients" 88 : 2714-2720, 2006

11 Arciero RA, "Spontaneous unstable burst fracture of the thoracolumbar spine in osteoporosis. A report of two cases" 14 : 114-117, 1989

12 Heinig CF, "Segmental Spinal Instrumentation" Slack 221-234, 1984

13 Gertzbein SD, "Scoliosis Research Society. Multicenter spine fracture study" 17 : 528-540, 1992

14 Ha KY, "Risk factors affecting progressive collapse of acute osteoporotic spinal fractures" 24 : 1207-1213, 2013

15 Abel R, "Residual deformity of the spinal canal in patients with traumatic paraplegia and secondary changes of the spinal cord" 37 : 14-19, 1999

16 Hashidate H, "Pseudoarthrosis of vertebral fracture : radiographic and characteristic clinical features and natural history" 11 : 28-33, 2006

17 Patil S, "Predictors of kyphotic deformity in osteoporotic vertebral compression fractures : a radiological study" 23 : 2737-2742, 2014

18 Lehmer SM, "Posterior transvertebral osteotomy for adult thoracolumbar kyphosis" 19 : 2060-2067, 1994

19 Malcolm BW, "Post-traumatic kyphosis. A review of forty-eight surgically treated patients" 63 : 891-899, 1981

20 Ito Y, "Pathogenesis and diagnosis of delayed vertebral collapse resulting from osteoporotic spinal fracture" 2 : 101-106, 2002

21 Wu SS, "Management of rigid posttraumatic kyphosis" 21 : 2260-2266, 1996

22 Coe JD, "Influence of bone mineral density on the fixation of thoracolumbar implants. A comparative study of transpedicular screws, laminar hooks, and spinous process wires" 15 : 902-907, 1990

23 Kummell Hs, "Der heutige Standpunkt der posttraumatischen Wir-belerkrankung(“Kummelshce Krankheit’)" 26 : 471-502, 1928

24 Young WF, "Delayed post-traumatic osteonecrosis of a vertebral body(Kummell’s disease)" 68 : 13-19, 2002

25 Lee JH, "Comparison of the Posterior Vertebral Column Resection with the Expandable Cage versus the Nonexpandable Cage in Thoracolumbar Angular Kyphosis" 2016

26 Sugita M, "Classification of vertebral compression fractures in the osteoporotic spine" 18 : 376-381, 2005

27 Tsujio T, "Characteristic radiographic or magnetic resonance images of fresh osteoporotic vertebral fractures predicting potential risk for nonunion : a prospective multicenter study" 36 : 1229-1235, 2011

28 Gurr KR, "Biomechanical analysis of anterior and posterior instrumentation systems after corpectomy. A calf-spine model" 70 : 1182-1191, 1988

29 Suk SI, "Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture" 28 : 2170-2175, 2003

30 Streitz W, "Anterior fibular strut grafting in the treatment of kyphosis" 140-148, 1977