Effects of vertebroplasty for delayed-onset paraplegia caused by vertebral pseudarthrosis

Abstract

BackgroundThe effectiveness of percutaneous vertebroplasty for osteoporotic vertebral pseudarthrosis with delayed-onset paraplegia has not been reported. We performed vertebroplasty for such patients and tried to investigate the effectiveness of this surgery. MethodsWe studied 11 patients (2001–2007) treated with percutaneous vertebroplasty for osteoporotic vertebral pseudarthrosis with delayed-onset paraplegia. The mean age of the patients was 71.9 ± 5.2 years and the affected vertebrae were located in the thoracolumbar junction. The mean period between the onset of motor weakness and the day of the surgery was 9.5 ± 5.7 weeks. Vertebroplasty was performed by filling the intravertebral cleft with polymethylmethacrylate. The clinical course was estimated using the Denis pain scale, the Eastern Cooperative Oncology Group performance status scale and the modified Medical Research Council grade before the surgery, 0, 1, 3, 6 months and 1 year following the surgery, and at the latest follow-up visit. The instability angle and local kyphotic angle were evaluated with X-rays. ResultsSignificant improvements were observed in the pain scale in all patients, as they did not experience severe pain, and the performance status following the surgery. These conditions continued until the final clinical examination. Most patients had motor weakness, with a preoperative manual motor test score of 0–3, which gradually improved to 4–5 over the examination period. The stabilities of the affected vertebrae were confirmed on imaging at the final examination. Kyphotic changes were initially realigned, but a correction loss occurred in 7 of the 11 patients as a result of adjacent vertebral fractures. Increase in kyphosis following the surgery did not affect the muscle strength recovery. Bridging callus formations were observed around the affected vertebrae within 6 months in all cases. ConclusionPercutaneous vertebroplasty for vertebral pseudarthrosis with delayed-onset paraplegia is effective for recovering muscle strength, improving performance status and relief from pain, despite local kyphosis.