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Brook AD, Clerk-Lamalice O, De Leacy RA, Brook AL, Hirsch JA. Armed kyphoplasty-the future? J Neurointerv Surg 2024; 16:435. [PMID: 38448228 DOI: 10.1136/jnis-2024-021575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Andrew D Brook
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Olivier Clerk-Lamalice
- Interventional Spine Service, Beam Interventional & Diagnostic Imaging, Calgary, Alberta, Canada
| | - Reade A De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Allan L Brook
- Interventional Neuroradiology, Montefiore Medical center, Bronx, New York, USA
| | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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Li J, Xu L, Liu Y, Sun Z, Wang Y, Yu M, Li W, Zeng Y. Open Surgical Treatments of Osteoporotic Vertebral Compression Fractures. Orthop Surg 2023; 15:2743-2748. [PMID: 37587622 PMCID: PMC10622270 DOI: 10.1111/os.13822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 08/18/2023] Open
Abstract
With an aging population, the osteoporotic vertebral compression fracture (OVCF) has become a constant concern for its physical and neurological complications, such as spinal kyphosis and refractory pains. Compared with traditional conservative treatments, the open surgery is more superior in some ways because of its direct decompression and correction. Various operation methods applying to different indications have been developed to deal with different fracture situations, including anterior, posterior, and combined surgery. In this review, we have concluded the latest developments of the surgery treating OVCF and the internal fixation as references for spinal surgeons of the choice of suitable treatments.
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Affiliation(s)
- Junyu Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Lizhi Xu
- School of Basic Medical SciencesPeking University Health Science CenterBeijingChina
| | - Yinhao Liu
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Zhuoran Sun
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yongqiang Wang
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Miao Yu
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Weishi Li
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
| | - Yan Zeng
- Department of OrthopaedicsPeking University Third HospitalBeijingChina
- Engineering Research Center of Bone and Joint Precision MedicineBeijingChina
- Beijing Key Laboratory of Spinal Disease ResearchBeijingChina
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Wang K, Zhang W, Zhai Y, Zhang F, Yin W, Sun L, Hua Z, Cui X, Yu H. Effect of Position on Regional Kyphosis Angle in Patients with Kyphosis Secondary to Symptomatic Old Osteoporotic Thoracolumbar Fracture. World Neurosurg 2023; 171:e731-e737. [PMID: 36581156 DOI: 10.1016/j.wneu.2022.12.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of position on regional kyphosis angle (RKA) in patients with kyphosis secondary to symptomatic old osteoporotic thoracolumbar fracture (so-OTLF). METHODS The authors evaluated the radiographic data of patients with kyphosis secondary to so-OTLF who underwent posterior corrective fusion surgery in our hospital. The spine sagittal parameters were evaluated in the standing position preoperatively. RKA was measured under standing radiograph, full-length spine computed tomography image in prone position and intraoperative prone X-ray radiograph, respectively. Changes in RKA were compared between groups. RESULTS Thirty-three patients were included. The average RKAs in the standing position, preoperative prone position, and intraoperative prone position were 46.2°, 31.1°, and 30.5° respectively. RKA decreased significantly from standing to preoperative prone position or intraoperative prone position (P < 0.001). In 93.9% (31/33) of the patients, the difference between preoperative prone RKA and intraoperative prone RKA was within 5°. The changes in RKA from standing to intraoperative prone position in the moderate to severe kyphosis group were significantly greater than those in the mild kyphosis group (P < 0.001). CONCLUSIONS The reductive effect of the intraoperative prone position was greater in patients with moderate to severe kyphosis deformities. RKA in the preoperative prone position was almost the same as the RKA in the intraoperative prone position. Therefore, assessing preoperative full-length spine computed tomography in the prone position helped formulate the plan for corrective surgery in patients with kyphosis secondary to so-OTLF.
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Affiliation(s)
- Kangkang Wang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Wei Zhang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Yunlei Zhai
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Feng Zhang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Wen Yin
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Lele Sun
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Zikai Hua
- School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China
| | - Xilong Cui
- School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China
| | - Haiyang Yu
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China; School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China.
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Koepke LG, Weiser L, Stangenberg M, Dreimann M, Heuer A, Strahl A, Viezens L. Outcome after Posterior Vertebral Column Resection in Patients with Severe Osteoporotic Fractures—A Retrospective Analysis from Two Centers. Medicina (B Aires) 2022; 58:medicina58020277. [PMID: 35208600 PMCID: PMC8879154 DOI: 10.3390/medicina58020277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: In osteoporotic fractures of the spine with resulting kyphosis and threatening compression of neural structures, therapeutic decisions are difficult. The posterior vertebral column resection (pVCR) has been described by different authors as a surgical treatment in a single-stage posterior procedure. The aim of this study is to evaluate midterm outcomes of patients treated by pVCR due to severe osteoporotic fractures. Materials and Methods: Retrospective data analysis of all the patients treated for osteoporotic fractures by pVCR from 2012–2020 at two centers was performed. Demographic data, visual analog scale (VAS), Frankel scale (FS), Karnofsky performance status (KPS), radiological result and spinal fusion rates were evaluated. Results: A total of 17 patients were included. The mean age was 70 ± 10.2 y. The mean VAS decreased significantly from 7.7 ± 2.8 preoperatively to 3.0 ± 1.6 at last follow-up (p < 0.001) and the segmental kyphosis decreased from 29.4 ± 14.1° to 7.9 ± 8.0° (p < 0.001). The neurologic function on the FS did not worsen in any and improved in four of the patients. The median KPS remained stable over the whole observation period (70% vs. 70%). Spinal fusion was observed in nine out of nine patients who received CT follow-up >120 days after index surgery. Conclusions: This study showed that pVCR is a safe surgical technique with few surgical complications and no neurological deterioration considering the cohort. The patients’ segmental kyphosis and VAS improved significantly, while the KPS remained stable.
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Affiliation(s)
- Leon-Gordian Koepke
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.S.); (M.D.); (A.H.); (L.V.)
- Correspondence: ; Tel.: +49-17632605843
| | - Lukas Weiser
- Clinic for Trauma, Orthopedics and Plastic Surgery, University Medical Center Göttingen, Georg-August-Universität, 37075 Göttingen, Germany;
| | - Martin Stangenberg
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.S.); (M.D.); (A.H.); (L.V.)
| | - Marc Dreimann
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.S.); (M.D.); (A.H.); (L.V.)
| | - Annika Heuer
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.S.); (M.D.); (A.H.); (L.V.)
- Mildred Scheel Cancer Career Center HaTriCS4, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - André Strahl
- Division of Orthopedics, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Lennart Viezens
- Division of Spine Surgery, Department of Trauma and Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.S.); (M.D.); (A.H.); (L.V.)
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Terai H, Takahashi S, Yasuda H, Konishi S, Maeno T, Kono H, Matsumura A, Namikawa T, Kato M, Hoshino M, Tamai K, Toyoda H, Suzuki A, Nakamura H. Differences in surgical outcome after anterior corpectomy and reconstruction with an expandable cage with rectangular footplates between thoracolumbar and lumbar osteoporotic vertebral fracture. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 6:100071. [PMID: 35141636 PMCID: PMC8819965 DOI: 10.1016/j.xnsj.2021.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
Background Anterior and posterior spinal fixation (APSF) can provide rigid structural anterior column support in patients with osteoporotic vertebral fracture (OVF). A new rectangular footplate designed based on biomechanical studies of endplates provides better resistance to subsidence. However, differences in characteristics exist between the thoracolumbar and lower lumbar spine. The purpose of this study was to evaluate the surgical outcomes following APSF using an expandable cage with rectangular footplates in the thoracolumbar/lumbar region. Methods Consecutive patients who underwent APSF for OVF at multiple centers were retrospectively reviewed. Clinical and radiographic evaluations were performed by dividing the patients into thoracolumbar (TL, T10–L2) and lumbar (L, L3–L5) groups. Surgical indications were incomplete neurologic deficit or intractable back pain with segmental spinal instability. Surgical outcomes including the Japanese Orthopaedic Association (JOA) score and reoperation rate were compared between TL and L groups. Results Sixty-nine patients were followed-up for more than 12 months and analyzed. Operative intervention was required for 35 patients in the TL group and 34 patients in the L group. Mean ages in the TL and L groups were 76.5 years and 75.1 years, respectively. Intra-vertebral instability was more frequent in the TL group (p<0.001). Screw fixation range was significantly longer in the TL group (p=0.012). The rate of cage subsidence did not differ significantly between the TL group (46%) and L group (44%). Reoperation rate tended to be higher in the TL group (p=0.095). Improvement ratio of JOA score was significantly better in the L group (60%) than in the TL group (46.9%, p=0.029). Conclusion APSF using an expandable cage was effective to treat OVF at both lumbar and thoracolumbar levels. However, the improvement ratio of the JOA score was better in the L group than in the TL group.
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Wang HW, Hu YC, Wu ZY, Wu HR, Ma JQ, Jian HQ, Ning SH, Xu WK. One Approach Anterior Decompression and Fixation with Posterior Unilateral Pedicle Screw Fixation for Thoracolumbar Osteoporotic Vertebral Compression Fractures. Orthop Surg 2021; 13:908-919. [PMID: 33787067 PMCID: PMC8126897 DOI: 10.1111/os.12947] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022] Open
Abstract
Objective The objective of the present paper was to explore the clinical effect of one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation for thoracolumbar osteoporosis vertebral compression fractures (OVCF). Methods This is a single‐center retrospective analysis. A total of six thoracolumbar OVCF patients (four women and two men) with an average age of 65.2 years (58–72 years) who were treated between June 2016 and May 2018 were enrolled in the present study. The lesion segments included: 1 case at T11, 1 case at T12, 3 cases at L1, and 1 case at L2. The six thoracolumbar OVCF patients were treated with one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation. After general anesthesia, patients were placed in the right lateral decubitus position, an approximately 10–15‐cm oblique incision was made along corresponding ribs, and the conventional left retroperitoneal and/or the extrapleural approach was performed for anterior lateral exposure. First, anterior decompression and fixation were performed, and then through the unilateral paraspinal muscle approach, posterior pedicle screw fixation was performed under the same incision. The back pain visual analogue scale (VAS), the Oswestry disability index (ODI), and the MacNab criteria were used to evaluate the clinical outcome. The radiographic analysis included the regional kyphosis angle and the fusion rate. Neurological status, operation time, intraoperative bleeding, the time of ambulation, hospital stay, and surgical complications were also assessed. Results Surgery was successful in all six patients, who were followed up for 31.6 months (range, 23–46 months). The operation time was 125–163 min, with a median of 135 min. The preoperative blood loss was 580–1230 mL, with a median of 760 mL. The time of ambulation was 3–5 days, with a median of 4.2 days. The hospital stay was 8–15 days, with the median of 10.5 days. According to the Frankel classification of neurological deficits, of two patients with grade C preoperatively, one had improved to grade D and one had improved to grade E at final follow up; among four patients with grade D preoperatively, at the final follow up one remained the same and three had improved to grade E. The postoperative back pain VAS score decreased significantly, from 6.17 ± 0.75 preoperatively to 0.83 ± 0.41 postoperatively (P < 0.05). The mean ODI score was 73.7 ± 5.86 preoperatively and reduced to 21.85 ± 3.27 postoperatively (P < 0.05). According to the MacNab criteria, at the final follow up, two patients rated their satisfaction as excellent, three patients as good, and one patient as fair. The mean regional kyphosis angle was 22.17° ± 6.01°before surgery, which improved to 9.33° ± 3.88° at the final follow up (P < 0.05). At the final follow up, there were two patients who had achieved a grade 2 bony fusion (33.3%), three patients grade 3 (50.0%), and one patient grade 4 (16.7%). No incision infections, internal fixation failures or other complications were found during the perioperative and the follow‐up period. Conclusion One approach anterior decompression and fixation with posterior unilateral pedicle screw fixation provides a novel method for thoracolumbar OVCF disease, with a satisfactory clinical outcome.
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Affiliation(s)
- Hui-Wang Wang
- Department of Orthopaedics, Orthopaedic Hospital, Xingtai, China
| | - Yong-Cheng Hu
- Department of Spinal Surgery, Tianjin Hospital, Tianjin, China
| | - Zhan-Yong Wu
- Department of Orthopaedics, Orthopaedic Hospital, Xingtai, China
| | - Hua-Rong Wu
- Department of Orthopaedics, Orthopaedic Hospital, Xingtai, China
| | - Jian-Qing Ma
- Department of Orthopaedic Laboratory, Xingtai Institute of Orthopaedics, Xingtai, China
| | - Hui-Qiu Jian
- Department of Orthopaedics, Orthopaedic Hospital, Xingtai, China
| | - Sheng-Hua Ning
- Department of Orthopaedics, Orthopaedic Hospital, Xingtai, China
| | - Wen-Kun Xu
- Department of Orthopaedics, Orthopaedic Hospital, Xingtai, China
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Pehlivanoglu T, Erdag Y, Oltulu I, Akturk UD, Korkmaz E, Yildirim K, Sarioglu E, Gun K, Ofluoglu E, Aydogan M. Unilateral Posterior Surgery for Severe Osteoporotic Vertebrae Fractures' Sequelae in Geriatric Population: Minimum 5-Year Results of 109 Patients. Neurospine 2021; 18:319-327. [PMID: 33657776 PMCID: PMC8255769 DOI: 10.14245/ns.2040812.406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/25/2021] [Indexed: 11/21/2022] Open
Abstract
Objective This study aimed to evaluate the efficacy and safety of modified posterior vertebral column resection (PVCR) combined with anterior column restoration in elderly patients presenting with thoracic or thoracolumbar osteoporotic fractures with spinal cord compression and severe pain.
Methods One hundred nine patients with one level thoracolumbar osteoporotic fracture and at least 5 years of follow-up were included. They underwent posterior instrumentation performed with polymethymetachrylate augmented pedicle screws. A modified PVCR (unilateral costotransversectomy+hemilaminectomy) combined with the insertion of an expandable titanium cage for anterior column restoration was undertaken. Patients were evaluated clinically and radiographically.
Results Patients had a mean age of 74.1 and a follow-up duration of 92.3 months. Mean duration of operations, hospital stays, and mean loss of blood were 172.3 minutes, 4.3 days, and 205.4 mL. All of the patients were mobilized immediately after surgery. The mean preoperative local kyphosis angle improved from 39.3° to 4.7° at the last follow-up (p = 0.003). Patients preoperative mean visual analogue score, Japanese Orthopaedic Association, and Oswestry Disability Index scores improved from 7.7/8.6/76.3 to 1.6/26.1/17.4 (p < 0.001 for all), respectively. The average 36-item Short-Form survey physical component summary/mental component summary scores at the last follow-up were 55.1/56.8. A dural tear was detected intraoperatively in 1 patient and repaired immediately.
Conclusion Subtotal PVCR combined with the insertion of an expandable titanium cage was detected as a safe and effective method for osteoporotic vertebrae fractures’ sequelae in the older population involving spinal cord compression by enabling the decompression of the spinal canal and reconstruction of the resected segment, resulting in significant improvement in clinical and radiographic outcomes.
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Affiliation(s)
- Tuna Pehlivanoglu
- Yeni Yuzyil University, Faculty of Health Sciences, Istanbul, Turkey.,Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Yigit Erdag
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Ismail Oltulu
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | | | - Emre Korkmaz
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Kerem Yildirim
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Ender Sarioglu
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Kerem Gun
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Ender Ofluoglu
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
| | - Mehmet Aydogan
- Emsey Hospital, Advanced Spine Surgery Center, Istanbul, Turkey
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Lee JS, Ahn DK, Shin WS, Cho KJ, Ko YR, Whang IC. Vertebral Body Anterior Translation, a Novel Technique for Delayed Myelopathy Due to Osteoporotic Spine Fractures. Clin Orthop Surg 2020; 12:485-492. [PMID: 33274026 PMCID: PMC7683192 DOI: 10.4055/cios20028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/17/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUD Osteoporotic vertebral compression fractures (OVCFs) are often associated with delayed myelopathy. Surgical treatment of delayed myelopathy following an OVCF comprises spinal canal decompression and stable fixation of the vertebral column with an acceptable sagittal alignment. However, such surgical methods are not usually feasible because of medical comorbidities and osteoporosis. We devised a novel, simple technique to decompress the spinal canal and reconstruct the middle column by translating the fractured vertebral body anteriorly through a posterior approach and verified the validity of the new technique. METHODS We conducted a single-center, retrospective study. Patients who underwent vertebral body anterior translation (VBaT) between 2014 and 2017 due to delayed myelopathy after OVCFs were included. Through a posterior approach, discs between the fractured vertebra and the adjacent vertebrae were released. The fractured vertebra was translated anteriorly with pedicle screws and rods to realign the middle column. Radiological and functional improvement was analyzed. RESULTS There were 12 consecutive patients. The mean age was 70.3 ± 9.4 years. There were 8 female and 4 male patients. Follow-up period was 35.9 ± 13.1 months. Nine patients had pedicle screw augmentation with polymethyl methacrylate. The mean number of fusion segments was 3.4 (range, 2-4). There were 3 types of spinal canal invasion. Five patients had vertebral body vacuum clefts with posterior wall fractures. Five patients had vertebral body angulation with endplate protrusion. Two patients had 3 column fractures. In radiological analysis, the regional kyphotic angle was 35.1° ± 9.1° preoperatively and improved to 8.8° ± 6.8° postoperatively and 9.8° ± 6.1° at the final follow-up (p < 0.001). The anterior vertebral body height ratio was 27.6% ± 7.0% preoperatively and improved to 80.5% ± 13.7% postoperatively and 83.7% ± 12.5% at the final follow-up (p < 0.001). The spinal canal invasion ratio was 52.6% ± 9.1% preoperatively and improved to 25.2% ± 10.4% postoperatively (p < 0.001). Neurological deficit was improved in all patients by 1-3 grades according to Nurick's grading system. CONCLUSIONS In delayed myelopathy following an OVCF, although the posterior cortex invades the spinal canal, it is usually already in the union state. Therefore, it can bear compression force as a middle column if realigned to be in line with the adjoining vertebrae. VBaT demonstrated satisfactory reduction of kyphosis and maintenance of stability until the last follow-up.
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Affiliation(s)
- Jung Soo Lee
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Dong Ki Ahn
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Won Shick Shin
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Kyung Jun Cho
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Young Rok Ko
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
| | - Il Chan Whang
- Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea
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Han MS, Lee SS, Lee SK, Jang JW, Moon BJ, Lee JK. Single-Stage Posterior Circumferential Stabilization Using Double Small Cages for the Treatment of Thoracic and Lumbar Spine Fractures. World Neurosurg 2020; 144:e701-e709. [PMID: 32949794 DOI: 10.1016/j.wneu.2020.09.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Controversy remains regarding the optimal methods for resection of the vertebral body, reconstruction of the anterior column, and decompression of the spinal cord in patients who have severe vertebral body destruction of the thoracic or lumbar spine with associated neurologic impairment. We report an alternative technique for primary treatment and salvage involving single-stage corpectomy followed by reconstruction of the anterior column using double small mesh cages via the posterior-only approach. METHODS Plain radiographs and computed tomography scans, taken at different intervals, were used to measure local kyphosis, segmental height, and fusion grade. Pain was evaluated using the visual analog scale (VAS), and neurologic symptoms were classified according to Frankel grade. RESULTS The mean kyphotic deformity improved by 14.47 ± 9.06 degrees (P < 0.001), and the mean segmental height improved by 7.17 mm ± 6.11 mm (P < 0.001) after surgery. Fusion was achieved at 84% of patients, within a median interval of 12 months. Kyphotic recurrence was observed in 2 patients (11%), segmental height loss occurred in 1 patient (5%), and both kyphotic recurrence and segmental height loss occurred in 1 patient (5%). None of the patients reported worsening pain or neurologic symptoms after surgery, and there were no surgery-related complications such as neural injury, cerebrospinal fluid leakage, cage dislocation, surgical site infection, or cardiopulmonary complications. CONCLUSIONS Single-stage corpectomy followed by reconstruction of the anterior column using double small mesh cages via the posterior-only approach is a reliable and less invasive single-stage treatment and salvage option in selected cases.
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Affiliation(s)
- Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Shin-Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Seul-Kee Lee
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Jae-Won Jang
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Bong Ju Moon
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea
| | - Jung-Kil Lee
- Department of Neurosurgery, Chonnam National University Hospital and Medical School, Gwangju, South Korea.
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Sehmisch S, Lehmann W, Dreimann M, Oberthür S, Viezens L, Weiser L. [Posterior vertebral column resection for correction of kyphotic deformity due to osteoporotic fractures of the thoracic spine]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2019; 31:311-320. [PMID: 31278505 DOI: 10.1007/s00064-019-0616-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/25/2019] [Accepted: 04/02/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The posterior vertebral column resection (PVCR) comprises a one-step resection of the vertebral body by a costotransversectomy together with a 360° spondylodesis. After removing the vertebral body, straightening of the existing kyphotic malposition is possible. INDICATIONS Pronounced thoracic kyphosis after osteoporotic sintering fractures in one or more vertebral bodies. CONTRAINDICATIONS General contraindications for surgical procedures, ASA >3 (American Society of Anesthesiologists). SURGICAL TECHNIQUE First, dorsal stabilization of the vertebral column on at least two levels cranial and caudal of the VCR. Next, in a one-step procedure the laminectomy with costotransversectomy and the resection of the vertebral body is done. The ventral defect gap is filled by a mesh cage to provide ventral support. By compression the malposition is reduced and the mesh cage is fixed into position. Finally the vertebrae joints are opened up using a chisel and bone or bone substitute is placed to complete the 360° spondylodesis. POSTOPERATIVE MANAGEMENT Functional treatment without peak load exercises as well as appropriate osteoporosis treatment. RESULTS In a retrospective study 10 patients treated with this surgical technique were investigated. The results show a very good correction of the kyphotic maldeformity while the complications remain moderate.
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Affiliation(s)
- S Sehmisch
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
| | - W Lehmann
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - M Dreimann
- Klinik und Poliklinik für für Unfall‑, Hand- und Wiederherstellungschirurgie, Spine Center, Universitätsklinikum Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
| | - S Oberthür
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - L Viezens
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
| | - L Weiser
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland
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