Severe progressive osteoporotic spine deformity with cardiopulmonary impairment in a young patient - A case report

Study Design. This report describes a young patient with a rapidly progress ive kyphosis caused by collapse of a severely osteoporotic thoracolumbar sp ine, which led to impairment of cardiopulmonary function. Objectives. To highlight the treatment strategy, difficulty of diagnosis, o perative stabilization, and outcome. Summary of Background Data. Little is known about natural history, treatmen t options, and results of this condition. Methods. The magnitude of bone loss was measured by dual-energy x-ray absor ptiometry, and the deformity was visualized by computed tomography and magn etic resonance imaging. Laboratory investigations also were performed befor e and during halotraction in an attempt to establish a diagnosis. These dat a constituted the preoperation information required to assess later results of medical and surgical intervention. Results. An extensive evaluation of possible underlying etiologies failed t o identify a specific etiology. Before and during halotraction, bone minera l substitutes were given, partially correcting the bone mineral content as measured on repeated dual-energy x-ray absorptiometry scans. In addition, t he thoracic kyphosis was partially corrected, from 100 degrees to 70 degree s Cobb's angle. Subsequently, a combined anterior and posterior stabilizati on was performed from C7 to S1 using a vascularized fibula graft, a double Isola rod system (AcroMed, Cleveland, OH), and a carbonate apatite cancello us bone cement to reinforce the pedicle screws. At follow-up assessment 40 months surgery, the patient was asymptomatic and fully mobilized, with radi ographs showing complete incorporation of the grafts and no loosening of th e fixation device. Conclusions. The diagnostic and therapeutic difficulties of progressive spi ne deformity caused by severe osteoporosis in young patients emphasizes the importance of a thoroughly planned treatment strategy. Halotraction is rec ommended to stop progression of the deformity, or even partially correct it , a nd to allow time to search for the diagnosis and bone mineral substitut ion. Surgical treatment using vascularized fibular strut grafts and a stron g fixation device was successful. Biocompatible carbonated apatite cancello us bone cement was successfully used to reinforce pedicle screw fixation.