VERTEBRAL CRUSH FRACTURES WITH NEUROLOGIC AL COMPLICATIONS - A REPORTOF 6 CASES

Osteoporotic vertebral crash fractures with neurologic complications a re rarely reported in the literature. We report six new cases particul arly severe in which death occurred in two cases. The study group incl uded four women and two men with a mean age of 75 years (range: 72-79) . Vertebral collapse causing neurological deficit was T5, T9, T11 in t wo cases, L1 and L3. The mean number of vertebral collapses was three per patient (range: 1-9). Back pain appeared without traumatism 6 week s before admission (range: 1-24). Neurological complications appeared 2.5 weeks after back pain (range: 1-8). One patient suffered from a pa raplegia, three from a paraparesia with bladder dysfunction (n = 1). I n one case there was severe weakness of the levator muscles of the foo t and in another a L3 femoral neuralgia with severe bowel and bladder dysfunction. X-rays demonstrated backwards displacement of the posteri or cortex in three cases, an intravertebral vacuum phenomenon in two c ases and a heterogeneous appearance suggesting a malignancy in two cas es. Computed tomography, performed in four patients and tomography in one patient, demonstrated fragmentation of the vertebral body in all t he cases and vacuum phenomenon in four cases. Magnetic resonance imagi ng performed in four cases has confirmed the absence of epiduritis and a compression due to bony structures in two cases. A vertebral biopsy was performed in three cases. Osteoporosis was observed in all the ca ses and in two cases there was also an osteonecrosis. Surgical treatme nt was performed in three cases and conservative medical treatment in the other cases. After surgical treatment we have observed an absence of improvement of neurological complications in one case, an improveme nt in another and finally a full recovery in the last case. After cons ervative treatment we have noted in two cases an absence of improvemen t of neurological complications and in one case an improvement of neur ological deficit. Two patients died (one after medical treatment and a nother after surgical treatment).