An 83-year-old female was transferred to our care five weeks after
sustaining a T12 fracture from a fall in her home. She was initially
treated at an outside facility for two weeks with bed rest followed
by progressive ambulation in a lumbosacral corset. She was discharged
home. At home she developed increasing back pain and progressive
weakness over the next two weeks. When this weakness became more
apparent, she presented to another physician. She was noted to have
increased deformity at her fracture and spinal cord compression
and was transferred to our care.
Upon presentation to our facility, she was noted to have weakness
with a complete foot drop on the left and just a flicker of strength
on the right. She also had mild bowel and bladder dysfunction. X-rays
revealed a 75% compression deformity of T12 with 31° of local kyphosis
(Figure 1). CT myelogram revealed 60% canal compromise with complete
dye block at the level of the fracture (Figure 2). A mild L2 compression
deformity was also noted and determined to be an old fracture.
Despite the patient’s advanced age, she was found to be extremely
healthy and had been completely independent before her fall. After
consultation with patient and family, the decision was made to proceed
with surgical intervention. The procedure consisted of anterior
decompression and fusion with placement of titanium mesh cage filled
with bone graft. Posterior spinal fusion, performed through a separate
incision, was also required from T9 to L1 to provide adequate stability.
The patient tolerated the procedure surprisingly well. Three months
from surgery she has been weaned out of her TLSO brace. She has
had almost complete recovery of strength. She is able to walk without
any assistive devices and is once again independent. She also has
had return of normal bowel and bladder function. Follow-up x-rays
show that the correction of deformity to 16° kyphosis has been maintained
This patient developed an osteoporotic fracture from a low energy
fall, which is common in her age group. It is quite rare, however,
for such a fracture to progress to the point of causing spinal cord
compression and incomplete paraplegia. This development necessitated
aggressive surgical treatment which the patient was able to tolerate,
despite her advanced age, because of her excellent state of general
X-rays revealed a 75% compression deformity of T12
with 31° of local kyphosis.
CT myelogram revealed 60% canal compromise with complete
dye block at the level of the fracture.
Follow-up x-rays show that the correction of deformity
to 16° kyphosis has been maintained.