Improvement of spinal alignment and quality of life after corrective surgery for spinal kyphosis in patients with osteoporosis: a comparative study with non-operated patients

Miyakoshi, Naohisa; Hongo, Michio; Kobayashi, Takashi; Abe, Tomoki; Abe, Eiji; Shimada, Yasuhiro

doi:10.1007/s00198-015-3163-5

Cited by 27 publications

(18 citation statements)

References 33 publications

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“…Typically, one or more thoracolumbar vertebrae sustains an anterior wedge deformity as the anterior region of the vertebral body collapses (Ismail et al, 1999). In severe cases, the entire spine develops a senile kyphosis which can be painful and disabling (Francis et al, 2008;Miyakoshi et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Vertebroplasty reduces progressive ׳creep’ deformity of fractured vertebrae

Luo

Pollintine

Annesley-Williams

et al. 2016

Journal of Biomechanics

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Elderly vertebrae frequently develop an "anterior wedge" deformity as a result of fracture and creep mechanisms. Injecting cement into a damaged vertebral body (vertebroplasty) is known to help restore its shape and stiffness. We now hypothesise that vertebroplasty is also effective in reducing subsequent creep deformations. Twenty-eight spine specimens, comprising three complete vertebrae and the intervening discs, were obtained from cadavers aged 67-92 years. Each specimen was subjected to increasingly-severe compressive loading until one of its vertebrae was fractured, and the damaged vertebral body was then treated by vertebroplasty. Before and after fracture, and again after vertebroplasty, each specimen was subjected to a static compressive force of 1kN for 1h while elastic and creep deformations were measured in the anterior, middle and posterior regions of each adjacent vertebral body cortex, using a 2D MacReflex optical tracking system. After fracture, creep in the anterior and central regions of the vertebral body cortex increased from an average 4513 and 885 microstrains, respectively, to 54,107 and 34,378 microstrains (both increases: P<0.001). Elastic strains increased by a comparable amount. Vertebroplasty reduced creep in the anterior and central cortex by 61% (P=0.006) and 66% (P=0.017) respectively. Elastic strains were reduced by less than half this amount. Results suggest that the beneficial effects of vertebroplasty on the vertebral body continue long after the post-operative radiographs. Injected cement not only helps to restore vertebral shape and elastic properties, but also reduces subsequent creep deformation of the damaged vertebra.

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Section: Introductionmentioning

confidence: 99%

Vertebroplasty reduces progressive ׳creep’ deformity of fractured vertebrae

Luo

Pollintine

Annesley-Williams

et al. 2016

Journal of Biomechanics

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“…Also, patients with the apex at a caudal level seemed to have less self-esteem issues with increasing magnitude of the kyphotic deformity [22]. Quality of life including physical functioning improved after corrective spinal surgery in adult patients with a symptomatic thoracolumbar or lumbar kyphosis secondary to osteoporosis [23]. Patients with Scheuermann kyphosis showed that functional outcome significantly improved 2 to 8 years after surgery.…”

Section: Resultsmentioning

confidence: 99%

Treatment of thoracolumbar kyphosis in patients with mucopolysaccharidosis type I: results of an international consensus procedure

Kuiper

Langereis

Breyer³

et al. 2019

Orphanet J Rare Dis

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BackgroundIn all patients with mucopolysaccharidosis type I (MPS I), skeletal disease (dysostosis multiplex) is a prominent, debilitating, condition related complication that may impact strongly on activities of daily living. Unfortunately, it is not alleviated by treatment with hematopoietic cell transplantation (HCT) or enzyme replacement therapy (ERT). Although early kyphosis is one of the key features of dysostosis multiplex, there is no international consensus on the optimal management. Therefore, an international consensus procedure was organized with the aim to develop the first clinical practice guideline for the management of thoracolumbar kyphosis in MPS I patients.MethodsA literature review was conducted to identify all available information about kyphosis and related surgery in MPS I patients. Subsequently, a modified Delphi procedure was used to develop consensus statements. The expert panel included 10 spinal orthopedic surgeons, 6 pediatricians and 3 physiotherapists, all experienced in MPS I. The procedure consisted of 2 written rounds, a face-to-face meeting and a final written round. The first 2 rounds contained case histories, general questions and draft statements. During the face-to-face meeting consensus statements were developed. In the final round, the panel had the opportunity to anonymously express their opinion about the proposed statements.ResultsEighteen case series and case reports were retrieved from literature reporting on different surgical approaches and timing of thoracolumbar kyphosis surgery in MPS I. During the face-to-face meeting 16 statements were discussed and revised. Consensus was reached on all statements.ConclusionThis international consensus procedure resulted in the first clinical practice guideline for the management of thoracolumbar kyphosis in MPS I patients, focusing on the goals and timing of surgery, as well as the optimal surgical approach, the utility of bracing and required additional assessments (e.g. radiographs). Most importantly, it was concluded that the decision for surgery depends not only on the kyphotic angle, but also on additional factors such as the progression of the deformity and its flexibility, the presence of symptoms, growth potential and comorbidities. The eventual goal of treatment is the maintenance or improvement of quality of life. Further international collaborative research related to long-term outcome of kyphosis surgery in MPS I is essential as prognostic information is lacking.Electronic supplementary materialThe online version of this article (10.1186/s13023-019-0997-5) contains supplementary material, which is available to authorized users.

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“…13 There has been an increasing recognition of importance of sagittal balance and parameters because sagittal balance has been found to be significantly associated with patients' health-related quality of life (HRQOL). 4,14 Patients with low back pain and lumbar degenerative diseases are characterized by the loss of LL and the increase of PT, which may lead to severe sagittal imbalance that is analyzed as a result of the interaction of regional deformities and compensatory mechanisms to present as deformity patterns if these compensatory mechanisms do not manage to compensate for original deformities. 15,16 The compensatory mechanisms can occur in spine, pelvis, and/or lower limb areas and the mean objective is to extend the adjacent segments of the kyphotic spine to rebalance the axis of gravity, including: reduction of TK that can be observed in flexible spines, hyperextension of adjacent segments which can also limit the lumbar kyphosis to restore the sagittal balance, retrolisthesis, pelvis retroversion (increase of PT and rotation of the pelvis), knee flexion, and ankle extension.…”

Section: Discussionmentioning

confidence: 99%