New Delhi: Doctors have coined a new terminology “sternum-into-abdomen deformity” to describe a case of severe thoracolumbar kyphosis with abdominal compression causing gastric disturbance after treatment of an osteoporotic vertebral compression fracture.
In a study published in the journal Spine, Dr Krishna Kumar R, consultant spine surgeon and clinical associate professor at Amrita Institute of Medical Sciences, Kochi, Kerala, and Dr Lawrence G Lenke, professor of orthopaedic surgery at Columbia University Medical Centre, US and a world leader in spinal deformity surgery, report that treatment with a vertebral column resection (VCR) and fusion for realignment of focal kyphosis can improve the quality of life for patients with this condition.
“Management of osteoporotic vertebral compression fractures mainly aims at pain control and deformity reduction. VCR for decreasing abdominal compression due to the development of severe kyphosis after treatment of osteoporotic compression fractures has never been reported in the literature to our knowledge,” said the study authors.
The study describes the case of a 73-year-old cachectic patient who underwent vertebroplasty for a midthoracic compression fracture with progressive, severe kyphosis. “His condition worsened and spinal reconstruction with a 2-level VCR restored more normal sagittal alignment and decreased his gastric compression. His back pain decreased and his ability to tolerate oral intake returned,” according to the authors.
According to Dr Krishna Kumar, sternum-into-abdomen deformity is descriptive of the resultant severe kyphosis due to osteoporotic spinal fractures with prominent abdominal wall crease from sternal/lower rib cage pressure on the abdomen, causing gastrointestinal dysfunction severe enough to cause weight loss.
Multiple osteoporotic fractures cause progressive kyphosis, resulting in pulmonary and gastrointestinal dysfunction due to reduced volume of the thoracic/abdominal cavities. Gastrointestinal dysfunctions include gastroesophageal reflux, hiatal hernia, and dysphagia.
The study “describes a patient who had severe thoracolumbar kyphosis causing compression of his stomach by his sternum with lower rib cage, resulting in reduced gastric volume and leading to early satiety in spite of a good appetite. The patient became cachectic because of inadequate food intake and lost 25 lb (11.3 kg) of body weight,” said Dr Krishna Kumar.
“The patient was offered surgical realignment of his spinal deformity through an all posterior approach and was able to take adequate food and regained weight.
One must be mindful of gastric disturbances when treating patients with osteoporotic compression fractures,” he added.