Differences in surgical outcome after anterior corpectomy and reconstruction with an expandable cage with rectangular footplates between thoracolumbar and lumbar osteoporotic vertebral fracture

Terai, Hidetomi; Takahashi, Shinji; Yasuda, Hiroyuki; Konishi, Sadahiko; Maekawa, Takafumi; Kono, H; Matsumura, Akira; Namikawa, Takashi; Kato, Minori; Hoshino, Minoru; Tamai, Katsuto; Toyoda, Hiromitsu; Suzuki, Akinobu; Nakamura, Hiroaki

doi:10.1016/j.xnsj.2021.100071

Cited by 4 publications

(2 citation statements)

References 41 publications

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“…Mild global kyphosis deformities may be managed conservatively or sometimes may require isolated posterior column osteotomies [18]. In contrast, patients with fixed focal kyphotic deformities typically present with severe pain, early fatigue, forward leaning, and difficulty maintaining horizontal gaze [19], and may require more invasive methods depending on the desired correction.…”

Section: Discussionmentioning

confidence: 99%

A New Minimally Invasive Technique for Thoracolumbar Focal Kyphosis Due to Osteoporotic Vertebral Fracture

Tanaka,

Askar,

Kuwamat

et al. 2024

Preprint

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Study design: Technical note. Objectives: To present a new technique of treatment for a patient with thoracolumbar focal kyphosis due to osteoporotic verte-bral fracture (OVFs). Background : OVFs are common among the elderly population. Following a severe wedged fracture, patients often experience low back pain and disruptions in activities of daily living. Reconstruction surgeries, such as corpectomy, are among the treatment options for this condition. However, corpectomy requires longer surgical times and involves a significant amount of blood loss. Materials and Methods : An 80-year-old woman presented to our hospital with severe low back pain and gait disturbance. She had experienced an L2 OVF six years prior. Although she had no neurological deficit, she could not walk more than 200m due to pain. Preoperative spinal radiographs revealed severe sagittal malalignment, with the L2 vertebra collapsed and focal kyphosis of L1-3 measuring 34 degrees. Results: The patient underwent anterior and posterior surgery in the right decubitus position using a C-arm free technique. The surgical time was 133 minutes with an estimated blood loss of 100 ml. Hyperlordotic cages were inserted in the upper and lower disc space via a lateral approach, while percutaneous pedicle screws (PPS) were inserted from a posterior approach. These procedures were performed simultaneously under navigation guidance only. Post-operative images showed excellent spinal alignment, with local kyphosis reduced from 34 to 14 degrees, and no major or severe complications occurred. At one-year follow-up, the patient was able to walk smoothly, with her visual analogue scale for low back pain improving from 73mm to 13mm, and her Oswestry Disability Index improving from 53.3% to 13.3%. Conclusions/Level of Evidence : The simultaneous use of hyperlordotic cages and PPS is an effective and innovative navigation technique that yields promising outcomes for thoracolumbar focal kyphosis resulting from OVFs. This approach not only reduces surgical time but also minimizes intraoperative blood loss. Level V.

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Section: Discussionmentioning

confidence: 99%

A New Minimally Invasive Technique for Thoracolumbar Focal Kyphosis Due to Osteoporotic Vertebral Fracture

Tanaka,

Askar,

Kuwamat

et al. 2024

Preprint

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“…The most common complications of corpectomy cage placement include screw loosening and failure, cage subsidence, and cage dislocation [4][5][6][7][8]. Expandable cage subsidence in particular can be seen in nearly half of patients who undergo vertebral body corpectomy in the cervical and lumbar spine [9,10]. This is likely increased in patients who undergo multilevel corpectomy.…”

Section: Introductionmentioning

confidence: 99%

Cement Augmentation of Two-Level Lumbar Corpectomy Cage After Malposition: A Novel Salvage Procedure Technical Note

Hamad¹,

Ryvlin²,

Langro³

et al. 2022

Cureus

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Intervertebral cage mispositioning is an uncommon complication of a posterior lumbar corpectomy. Most frequently, cages are placed obliquely, laterally, or protruding. However, there are few reports of implanted cages that fail to contact the adjacent vertebral endplate and thus no descriptions of successful revisions. The objective of this case report is to report a unique case of minimally invasive rescue vertebroplasty with cement augmentation following a lumbar corpectomy that resulted in graft-endplate noncontact in a medically complicated patient A 60-year-old male with a history of active intravenous (IV) drug use, untreated hepatitis C virus (HCV) infection, and chronic malnourishment presented with low back pain. He had a history of vertebral osteomyelitis managed with intravenous antibiotics, although he was noncompliant with infusions. The diagnosis of L2-L3 discitis-osteomyelitis with intradiscal abscess causing cord compression was made using inpatient lumbar imaging. The initial intervention was accomplished with L2 and L3 vertebral corpectomy with decompression and expandable cage placement as well as a T10-pelvis posterior fixation. Despite the resolution of presenting symptoms, routine postoperative radiographs identified noncontact between the inferior surface of the cage and the superior endplate of the L4 vertebral body. Salvage therapy was pursued via fluoroscopy-guided vertebroplasty with cement augmentation to correct cage malposition. Secondary surgical intervention was successful in bringing the intervertebral cage into contact with the adjacent vertebral body. Lower extremity strength improved, and back pain was resolved. The postoperative motor examination remained unchanged after the rescue procedure. Accurate intraoperative cage placement can be difficult in patients with poor bone quality, especially in the setting of ongoing infection and cachexia. For this reason, routine postoperative imaging is crucial to assessing graft complications. In patients who are poor candidates for revision surgery, we demonstrate that an interventional radiology-based approach may be successful in correcting cage mispositioning and preventing further changes during healing and fusion.

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Risk Factors for Cage Subsidence in Minimally Invasive Lateral Corpectomy for Osteoporotic Vertebral Fractures

Iwata

Kotani

Sakuma

et al. 2023

Spine Surg Relat Res

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Differences in surgical outcome after anterior corpectomy and reconstruction with an expandable cage with rectangular footplates between thoracolumbar and lumbar osteoporotic vertebral fracture

Cited by 4 publications

References 41 publications

A New Minimally Invasive Technique for Thoracolumbar Focal Kyphosis Due to Osteoporotic Vertebral Fracture

A New Minimally Invasive Technique for Thoracolumbar Focal Kyphosis Due to Osteoporotic Vertebral Fracture

Cement Augmentation of Two-Level Lumbar Corpectomy Cage After Malposition: A Novel Salvage Procedure Technical Note

Risk Factors for Cage Subsidence in Minimally Invasive Lateral Corpectomy for Osteoporotic Vertebral Fractures

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