Anterior-Posterior Surgery Versus Posterior Eggshell Decompression in Post-Traumatic Kyphosis with Neurologic Compromised Osteoporotic Fracture

Anterior, posterior or anterior-posterior surgeries are usually recommended in cases of kyphotic deformities with neurologic deficit secondary to osteoporosis. However, combined anterior-posterior surgery is associated with significant morbidity in elderly patients.

Purpose: To compare the surgical results between anterior-posterior surgery and posterior eggshell procedures in posttraumatic kyphosis with neurologic compromised osteoporotic fracture.

Materials and Methods: Twenty-six post-traumatic kyphosis with neurologic compromised osteoporotic fracture patients subjected to correction either by anterior-posterior surgery (n=11) or posterior eggshell procedure (n=15) were analyzed retrospectively. The average age at the operation was 62.6 years (range: 50~82), male : female ratio was 12 : 14, and the average follow up was 3.5 years (range:2.1~5.4). Preoperative interval from injury to operation was 15.4 months (range: 1~36). Thoracolumbar (T12-L1) fracture was in 20 and lumbar fracture was in 6.

Results: In anterior-posterior group, the mean operation time was 351 minutes with a mean blood loss of 2892 ml. In the posterior eggshell group, the mean operative time was 215 minutes with blood loss of 1930 ml. Eighteen patients showed an postoperative improvement in Frankel grading, 7 (64%) in anterior-posterior and 11 (73%) in posterior eggshell procedure, respectively. There was no neurologic or vascular complications in either group. In anterior-posterior group, postoperative pneumonia was developed in 2 and superficial infection in 1. Distal screw loosening was detected in 4, 2 in anterior-posterior group and 2 in posterior eggshell group. One of them was treated by revision and others were treated by brace more than 6 mos.

Conclusions: Posterior eggshell procedure, even though technically demanding, showed a better surgical result with significant less operation time and blood loss. It is a preferable alternative to anterior-posterior surgery in post-traumatic kyphosis with neurologic compromised osteoporotic fracture.