A 16-year-old female who complained of hoarseness and left back pain. An abnormal shadow in the left superior mediastinum was observed in chest X-ray films. Thoracic aortogram revealed elongations of the aortic arch and two sacculated aneurysms located in the minor curvature of the arch. She was operated by median sternotomy and left collar incision. The left vagal nerve laid between the two aneurysms. The proximal aneurysmal wall seemed to be of normal thickness, but the distal aneurysmal wall was so thin that the intraluminal blood stream was visible. Aneurysmectomy and insertion of a Dacron patch were successfully performed under cardio-pulmonary bypass with selective cereberal perfusion. The postoperative course was uneventful.

STUDY DESIGN: A retrospective study. PURPOSE: To clarify the differences among the three major surgeries for osteoporotic vertebral fractures based on the clinical and radiological results. OVERVIEW OF LITERATURE: Minimally invasive surgery like balloon kyphoplasty has been used to treat osteoporotic vertebral fractures, but major surgery is necessary for severely impaired patients. However, there are controversies on the surgical procedures. METHODS: The clinical and radiographic results of patients who underwent major surgery for osteoporotic vertebral fracture were retrospectively compared, among anterior spinal fusion (group A, 9 patients), single-stage combined anterior-posterior procedure (group AP, 8 patients) and posterior closing wedge osteotomy (group P, 9 patients). Patients who underwent revision surgery were evaluated just before the revision surgery, and the other patients were evaluated at the final follow-up examination, which was defined as the end point of the evaluations for the comparison. RESULTS: The operation time was significantly longer in group AP than in the other two groups. The postoperative correction of kyphosis was significantly greater in group P than in group A. Although the differences were not significant, better outcomes were obtained in group P in: back pain relief at the end point; ambulatory ability at the end point; and average loss of correction. CONCLUSIONS: The posterior closing wedge osteotomy demonstrated better surgical results than the anterior spinal fusion procedure and the single-stage combined anterior-posterior procedure.
Aged* ; Back Pain ; Follow-Up Studies ; Humans ; Kyphoplasty ; Kyphosis ; Osteoporosis ; Osteotomy* ; Retrospective Studies ; Spinal Fusion* ; Surgical Procedures, Minimally Invasive