Case Report: Osteoporosis (Dr Menke)

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 (Figures 3-4).

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 health.

 

Figure 1. X-rays revealed a 75% compression deformity of T12 with 31° of local kyphosis.

Figure 2. CT myelogram revealed 60% canal compromise with complete dye block at the level of the fracture.

 

Figures 3-4. Follow-up x-rays show that the correction of deformity to 16° kyphosis has been maintained.

 

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