Osteoporotic Unstable Scoliosis In Lumbar Spine Associated With Progressive Hemi-Vertebral Compression Fractures Following Long -Term Glucocortisone Therapy

摘要

We report a complication caused by progressive hemi-vertebral compression fractures associated with steroid induced osteoporosis. Loss of spinal balance would accelerate the progressive compression fractures because of the fragility of spinal column. It is important to reconstruct the spinal alignment and to medicate the osteoporosis itself. Introduction The loss of spinal balance causes the progression compression fractures in osteoporotic patients(1,2,3,4). The surgical goal is not only the relief of the present complains, but also the prevention of the further complications after the surgical intervention. The careful surgical strategies must be made for the reconstruction of the spinal alignment and for the fragile vertebrae because of osteoporosis with medications. Case Report A sixty-four-year-old woman, who were medicated with predonisolone 10mg/day for nineteen years without treatment of osteoporosis because of AIHA (autoimmune hemolytic anemia), presented persistent left anterior thigh pain and sever low back pain. The first episode of acute low back pain occurred at 58 years old when fell on the floor. Lumbar scoliosis with left side vertebral fractures of L1 and L2 was demonstrated on x-ray examination (Fig.1a) and she was observed with NSAIDs conservatively and settled the clinical symptoms, but the subsequent discomfort and dull pain on the back were persistent. She presented, however, sever low back pain again and radiating pain in the left anterior thigh at 64 years old. On physical examination, she could not stand with one leg because of sever low back pain, and neurologically femoral nerve stretching test was positive in the left lower extremity. The lumbar scoliosis on the X-ray examination (Fig.1b) was progressed with L3 left hemi-vertebral fracture.