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Background context With the increase of the elderly population, osteoporotic vertebral fractures have been frequently reported. Surgical intervention is usually recommended in osteoporotic vertebral collapse with neurologic deficits. However, very few reports on surgical interventions exist. Purpose To compare surgical results of anterior and posterior procedures for treating osteoporotic thoracolumbar vertebral collapse with sustained neurologic deficits. Study design Retrospective comparative study. Patient sample Fifty patients who sustained osteoporotic thoracolumbar vertebral collapse with neurologic deficits were treated either by anterior decompression and strut graft (n=32) or by posterior decompression and pedicle screw fixation with vertebroplasty (n=18). Outcome measures Incidence of complications, sagittal Cobb angle, spinal canal encroachment, and Japanese Orthopedic Association score. Methods The authors retrospectively reviewed the results of a consecutive series of patients undergoing anterior decompression and strut graft or posterior decompression and pedicle screw fixation with vertebroplasty for osteoporotic thoracolumbar vertebral collapse with neurologic deficits. Operative notes, clinical charts, and radiographs were analyzed. Results Operative time was similar between the groups, but intraoperative blood loss was significantly lower in the posterior group. All patients showed neurologic recovery. No significant difference was observed in the neurologic improvement, kyphosis correction angle, and loss of correction. Perioperative respiratory complications were found in 11 patients (34%) in the anterior group. In the anterior group, early posterior reinforcement was required in patients with very low bone density below 0.60 g/cm 2 and/or in those with three segments of instrumentation for two vertebral collapses. Posterior group patients did not undergo additional surgery. Conclusions Anterior reconstruction for osteoporotic vertebral collapse is significant because anterior elements, particularly those at the thoracolumbar junction, play a major role in load bearing. However, difficulties arise when anterior reconstruction is performed in cases with very low bone density and in those with multiple vertebral collapse.

Background context In the cervical spine, the combination of ossification of the ligamentum flavum (OLF) and ossification of the posterior longitudinal ligament (OPLL) is rarely seen. There have been only four cases reported in the English literature. Purpose We describe two more cases that exhibited cervical myelopathy resulting from the combination of cervical OLF and OPLL and required surgery. A literature review with a comparative analysis between previous reports and present cases was also performed. Study design Case report and literature review. Patient sample Two patients with combined OLF and OPLL. Outcome measures Preoperative computed tomography, magnetic resonance imaging, and pathological findings from operative specimens were used to confirm the diagnoses. Methods A 76-year-old man (Case 1) presented with disturbance of gait and fine finger movement. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C3–C4 level. Computed tomography showed OPLL at the C2–C6 levels (segmental type) and OLF at the left C3–C4 level. The patient underwent posterior decompression and OLF resection. A 75-year-old man (Case 2) presented with sensory disturbance and muscle weakness in his bilateral upper extremities and disturbance in fine finger movements. Magnetic resonance imaging showed severe spinal canal stenosis and cord compression at the C2–C3 and C3 levels. Computed tomography showed OPLL at the C3–C7 levels (mixed type) and OLF at the left C2–C3 and C3 levels. The patient also underwent posterior decompression and OLF resection. Results In both cases, histological examination of the surgical specimens showed osseous tissue and enchondral ossification within the ligamentum flavum, and the diagnosis in each case was OLF. After surgery, both patients' symptoms immediately improved, and no recurrence was observed at 2 years after surgery. Conclusions We experienced two cases of cervical myelopathy resulting from the combination of OLF and OPLL in the cervical spine. The symptoms of myelopathy were treated successfully by laminectomy and laminoplasty with OLF resection in both cases. The literature review including the present two cases revealed that cervical OLF tended to occur adjacent or close to the margin of cervical OPLL, suggesting that the increased mechanical stress at the junction of OPLL may be a causative factor.

Purpose of study: The objectives of this study were to analyze the surgical results of cervical spine injuries associated with lateral mass and facet joint fractures retrospectively and to clarify the surgical indication and treatment strategies for these injuries. Methods used: From 1991 to 1999, 30 patients including 20 lateral mass fractures and 8 facet joint fractures received surgical treatments in our institution. The average age at surgery was 46 years. The injury types according to Allen's classification were compressive-extension in 26, lateral flexion in 3, and distractive-flexion in 1 patient. All patients, except one who required osteosynthesis for the separation fracture of the lateral mass, received exclusive posterior fusion with cervical pedicle screw system. From X-rays and magnetic resonance imaging (MRI) analyses, the fractures were classified into subtypes. The translation of fractured and adjacent vertebrae in the sagittal and coronal planes, vertebral body destruction and signal changes of disc and spinal ligaments (ALL, PLL, SSL and ISL) on MRI were evaluated. The number of stabilized segments and the spinal alignment were also evaluated at follow-up. of findings: The lateral mass fractures were divided into the following four subtypes: separation fracture in 11, comminution type in 4, split type in 5 and traumatic spondylolysis in 2. The superior and inferior articular process fractures and combination of both fractures were seen in six, one and one patient, respectively. The anterior translation of fractured vertebra was demonstrated in 77% of lateral mass fractures, whereas 24% and 10% of anterior translation was observed even in cephalad and caudal adjacent vertebrae, respectively. The alignment change in coronal plane was detected in 33% of lateral mass fractures. On MRI, the signal changes in ALL and disc were demonstrated in 76% and 25% of caudal and cephalad segments adjacent to fractured vertebra, respectively. The number of stabilized segments were 1.4, 1.67 and 2 in separation, comminution and split type, respectively. The fusion was completely achieved in all patients. However, the preservation of spinal segments resulted in fusion with the mild anterior translation in six patients. Relationship between findings and existing knowledge: Little is known about the detailed fracture type of lateral mass/facet fractures, initial instability, and a frequency of soft tissue injury. This study first analyzed these parameters. Overall significance of findings: The evaluation of spinal instability as well as the assessment of soft tissue injury on initial MRI was essential for the diagnosis and treatment of lateral mass and facet fractures. We successfully saved the stabilized segments in separation fractures or fractures with mild comminution based on the adjacent disc and ligaments evaluation. However, severely comminuted lateral mass fractures with coronal plane malalignment required two-level posterior fixation. The exclusive posterior stabilization with cervical pedicle screw system provides a short fusion as well as a normal spinal alignment even in the lateral mass fractures with severe spinal instability. Disclosures: Device or drug: cervical pedicle screw. Status: not approved. Conflict of interest: No conflicts.

CONCLUSIONS: Reduction of physiological curvatures in lumbar spine led to the increased risk of vertebral fracture by more than 3 fold. Importance of evaluating sagittal spinal alignment should be emphasized because it might indicate the risk of the first vertebral fracture, which is a strong predictor of subsequent fractures. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.