Thoracic and Lumbar Fractures Associated with Falls and Lumbar Stenosis, Treated with Kyphoplasty

INTRODUCTION: An association between patient falls and lumbar stenosis was noticed during a prospective study for a new procedure.

MATERIALS AND METHODS: The first 50 cases of kyphoplasty were reviewed prospectively to satisfy the credentialing process that this new procedure was not only efficacious but also safe.

RESULTS: In this series of the first 50 consecutive kyphoplasties there were three cases of lumbar stenosis not at the site of the fracture that required an open decompression. Early in the series the surgeon did not recognize the severity of the stenosis in a patient that needed a two level vertebral augmentation after multiple falls. Just by positioning the patient prone for vertebral stabilization of two fractures, a foot drop developed. CT scan post kyphoplasty proved that no cement was in the canal at either level. An MRI showed severe stenosis at an adjacent level. With surgical decompression delayed several months at the patient’s insistence, there has been only a partial recovery. Two other patients had their stenosis recognized at the time of their fall/fracture event by MRI. These two patients had a combined procedure of kyphoplasty and lumbar decompression under the same anesthetic and both did exceedingly well.

CONCLUSION: The older patient population that falls is also the older population that has lumbar stenosis. Further study is needed to determine the risk of falls when stenosis is present, as well as a correlation between a history of falling and the presence of stenosis.