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Yasuharaa T.,Sninkomonji Hospital | Yasuharaa T.,Okayama University | Takahashia Y.,Sninkomonji Hospital | Kumamotoa S.,Sninkomonji Hospital | And 12 more authors.
Acta Medica Okayama | Year: 2013

Some cases with lumbar degenerative diseases require multi-level fusion surgeries. At our institute, 27 and 4 procedures of 3- and 4-level fusion were performed out of a total 672 posterior lumbar interfu-sions (PLIFs) on patients with lumbar degenerative disease from 2005 to 2010. We present 2 osteo-porotic patients who developed proximal vertebral body fracture after 4-level fusion. Both cases presented with gait disability for leg pain by degenerative lumbar scoliosis and canal stenosis at the levels of Ll/2-4/5. After 4-level fusion using LI as the upper instrumented vertebra, proximal verte-bral body fractures were found along with the right pedicle fractures of LI in both cases. One of these patients, aged 82 years, was treated as an outpatient using a hard corset for 24 months, but the frac-tures were exacerbated over time. In the other patient, posterolateral fusion was extended from ThlO to L5. Both patients can walk alone and have been thoroughly followed up. In both cases, the frac-ture of the right LI pedicle might be related to the subsequent fractures and fusion failure. In consideration of multi-level fusion, LI should be avoided as an upper instrumented vertebra to prevent junctional kyphosis, especially in cases with osteoporosis and flat back posture.

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