• Spine J · Sep 2010

    Vertebral body fracture after anterolateral instrumentation and interbody fusion in two osteoporotic patients.

    • Karan Dua, Christopher K Kepler, Russel C Huang, and Anna Marchenko.
    • Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY 10021, USA.
    • Spine J. 2010 Sep 1;10(9):e11-5.

    Background ContextThe XLP plate is an anterolateral instrumentation system developed as a part of the eXtreme Lateral Interbody Fusion (XLIF) system for lateral transpsoas interbody fusion, an alternative to anterior interbody fusion.PurposeTo report two cases of atraumatic coronal plane vertebral body fractures in the early postoperative period after interbody fusion using XLIF cages, lateral plating using the XLP plate, and unilateral posterior pedicle screw instrumentation.Study DesignCase report. METHODS/SUMMARIES: Both patients were septuagenarian women with normal body mass indices and osteoporosis. The patients underwent L4-L5 XLIF with anterolateral instrumentation followed by posterior decompression and fusion using unilateral pedicle screws. In the early postoperative period (ResultsCoronal plane fractures occurred in 2 of 13 patients treated by the senior author using XLIF, the XLP plate, and unilateral pedicle screw instrumentation. Osteoporosis was likely a contributing factor in both patients. One potential mechanism for this unusual fracture pattern is subsidence of the cage with resultant cut-through of the fixed-angle screws through the osteoporotic vertebral body. Alternately, the fracture could have resulted from the stress riser created by the screw hole traversing an area of relative stress concentration directly adjacent to the cage.ConclusionCoronal plane vertebral fracture may occur in osteoporotic patients treated with XLIF and XLP lateral instrumentation. Unilateral pedicle screw instrumentation does not prevent this complication.Copyright 2010 Elsevier Inc. All rights reserved.

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