Modified grade 4 osteotomy for kyphosis due to old osteoporotic vertebral compression fractures

Liu, Fengyu; Zhao, Zheng-Qi; Ren, Liang; Gu, Zhen-Fang; Li, Feng; Ding, Wenyuan; Sun, Xian-Ze

doi:10.1097/md.0000000000013846

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…For the treatment of old OVCF, there is no international consensus. As mentioned earlier, many scholars have proposed classification for old OVCF, but there are many problems as follows: (1) The classification lacks clinical manifestations such as nerve damage; (2) There is no corresponding treatment plan for typing; (3) There is a duplication between the types, which does not guide clinical treatment well; (4) There is no specificity in the classification, which also contains high energy injury fractures. Therefore, based on the previous research, our study proposes five new types of grades, and proposed corresponding treatment plans for the grades.…”

Section: Discussionmentioning

confidence: 99%

Surgical options for symptomatic old osteoporotic vertebral compression fractures: A retrospective study of 238 cases

Zhou

Hao

Dong

et al. 2020

Preprint

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Background: Symptomatic osteoporotic vertebral compression fractures (OVCF) are increasing, as are acute and chronic pain episodes and progressive spinal deformities. However, there are no clear surgical treatment criteria for patients with these different symptoms. Therefore, this study aims to explore the surgical approaches for the treatment of OVCF with different symptoms and evaluate the feasibility of these surgical approaches.Methods: We retrospectively analyzed 238 symptomatic OVCF patients who entered our hospital from June 2013 to 2016. According to clinical characteristics and imaging examinations, these patients were divided into I-V grades and their corresponding surgical methods were developed. I, old vertebral fracture with no apparent instability, vertebral augmentation; II, old vertebral fracture with local instability, posterior reduction fusion internal fixation; III, old fractures with spinal stenosis, posterior decompression and reduction fusion and internal fixation; IV, old vertebral fracture with kyphosis, posterior osteotomy with internal fixation and fusion; V, a mixture of the above types, posterior osteotomy (decompression) with internal fixation and fusion. Postoperative visual analog score (VAS), oswestry disability index (ODI) scores, sagittal index (SI) and ASIA grades of neurological function were observed.Results: All 238 patients were followed up for 12-38 months, with an average follow-up of 18.5 months. After graded surgery, the VAS score, ODI score, and vertebral sagittal index SI of 238 patients were significantly improved, and the difference between the last follow-up results and the preoperative comparison was statistically significant (P˂0.05). Besides, the postoperative ASIA grades of 16 patients with nerve injury were improved from 14 patients with preoperative grade C, 2 patients with grade D to 4 patients with postoperative grade D and 12 patients with postoperative grade E.Conclusion: In this study, we concluded that graded surgery could better treat symptomatic old OVCF and restore spinal stability. This provides clinical reference and guidance for the treatment of symptomatic old OVCF in the future.

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Section: Discussionmentioning

confidence: 99%

Surgical options for symptomatic old osteoporotic vertebral compression fractures: A retrospective study of 238 cases

Zhou

Hao

Dong

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…The osteotomy sites were usually chosen at the apex of the deformity, and posterior column osteotomy (PCO), pedicle subtraction osteotomy (PSO), modified grade 4 osteotomy, and vertebral column resection (VSR) were chosen depending on the severity and pattern of the curvature. 18 , 19 PCO includes Smith–Petersen osteotomy (SPO) and Ponte osteotomy. SPO involves resection of the lower facet joint and joint capsule.…”

Section: Methodsmentioning

confidence: 99%

Distal Junctional Failures in Degenerative Thoracolumbar Hyperkyphosis

Wang,

Li,

et al. 2024

Orthopaedic Surgery

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ObjectiveDegenerative thoracolumbar hyperkyphosis (DTH) is a disease that negatively affects individual health and requires surgical intervention, yet the ideal surgical approach and complications, especially distal junctional failures (DJF), remain poorly understood. This study aims to investigate DJF in DTH and to identify the risk factors for DJF so that we can improve surgical decision‐making, and advance our knowledge in the field of spinal surgery to enhance patient outcomes.MethodsThis study retrospectively reviewed 78 cases (late osteoporotic vertebral compression fracture [OVCF], 51; Scheuermann's kyphosis [SK], 17; and degenerative disc diseases [DDD], 10) who underwent corrective surgery in our institute from 2008 to 2019. Clinical outcomes were assessed using health‐related quality of life (HRQOL) measures, including the visual analogue scale (VAS) scores for back and leg pain, the Oswestry disability index (ODI), and the Japanese Orthopaedic Association (JOA) scoring system. Multiple radiographic parameters, such as global kyphosis (GK) and thoracolumbar kyphosis (TLK), were assessed to determine radiographic outcomes. Multivariate logistic regression analysis was employed to identify the risk factors associated with DJF.ResultsHRQOL improved, and GK, TLK decreased at the final follow‐up, with a correction rate of 67.7% and 68.5%, respectively. DJF was found in 13 of 78 cases (16.7%), two cases had wedging in the disc (L3‐4) below the instrumentation, one case had a fracture of the lowest instrumented vertebrae (LIV), one case had osteoporotic fracture below the fixation, nine cases had pull‐out or loosening of the screws at the LIV and three cases (23.1%) required revision surgery. The DJF group had older age, lower computed tomography Hounsfield unit (CT HU), longer follow‐up, more blood loss, greater preoperative sagittal vertical axis (SVA), and poorer postoperative JOA and VAS scores (back). The change in TLK level was larger in the non‐DJF group. Post‐sagittal stable vertebrae (SSV) moved cranially compared with pre‐SSV.ConclusionAge, CT HU, length of follow‐up, estimated blood loss, and preoperative SVA were independent risk factors for DJF. We recommend fixation of the two vertebrae below the apex vertebrae for DTH to minimize surgical trauma.

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“…Bone cements were used in some patients with severe osteoporosis to strengthen the vertebral body or enhance the pullout resistance of pedicle screws. One unilateral temporary rod was fixed to maintain the spinal stability during the advanced‐grade osteotomy procedures 16,17 . After the osteotomy procedure, the osteotomy gap was gently closed with compression forces and a permanent rod was placed.…”

Section: Methodsmentioning

confidence: 99%

“…One unilateral temporary rod was fixed to maintain the spinal stability during the advanced‐grade osteotomy procedures. 16 , 17 After the osteotomy procedure, the osteotomy gap was gently closed with compression forces and a permanent rod was placed. Lastly, autologous bone grafts obtained from the osteotomy combined with allografts were placed over the instrumented levels after decortication.…”

Section: Methodsmentioning

confidence: 99%

Junctional Kyphosis after Correction with Long Instrumentation for Late Posttraumatic Thoracolumbar Kyphosis: Characteristics and Risk Factors

Zhou

et al. 2023

Orthopaedic Surgery

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Objective Junctional kyphosis is a common complication after corrective long spinal fusion for adult spinal deformity. Whereas there is still a paucity of data on junctional kyphosis, specifically among late posttraumatic thoracolumbar kyphosis (LPTK) patients. Thus, the aim of this study was to investigate the characteristics and risk factors of junctional kyphosis in LPTK patients receiving long segmental instrumented fusion. Methods We retrospectively reviewed a cohort of LPTK patients who had received long segmental instrumented fusion (>4 segments) in our center between January 2012 and January 2019. Radiographic assessments included the sagittal alignment, pelvic parameters, bone quality on CT images, and measurements of the cross‐sectional area (CSA, cross‐sectional area of muscle‐vertebral body ratio × 100) and fat saturation fraction (FSF, cross‐sectional area of fat‐muscle body ratio × 100) of paraspinal muscles. Patients in this study were divided into those with junctional kyphosis or failure (Group J) and those without (Group NJ) during follow‐up. Group J included patients with junctional kyphosis (Group JK) and patients with junctional failure (Group JF). Results A total of 65 patients (16 males and 49 females, average age 56.5 ± 23.4 years) were enrolled in this study. After (32.7 ± 8.5) months follow‐up, 15 patients (23.1%) experienced junctional kyphosis, and four of them deteriorated into junctional failure. Eighty percent (12/15) of junctional kyphosis was identified within 6 months after surgery. In comparison with Group NJ, Group J were older (P = 0.026), longer fusion levels (P < 0.001), greater thoracic kyphosis (P = 0.01), greater global kyphosis (P = 0.023), lower bone quality (P < 0.001), less CSA (P = 0.005) and higher FSF (P <0.001) of paraspinal muscles. Preoperative global kyphosis more than 48.5° (P = 0.001, odds ratio 1.793) and FSF more than 48.4 (P = 0.010, odds ratio 2.916) were identified as independent risk factors of junctional kyphosis. Based on the statistical differences among Group NJ, Group JK and Group JF (P < 0.001), Group JF had lower bone quality than Group NJ (P < 0.001) and Group JK (P = 0.015). In terms of patient‐reported outcomes, patients in Group JF had worse outcomes in ODI and VAS scores, and PCS and MCS of SF‐36 than Group NJ and group JK Conclusion The prevalence of junctional kyphosis was 23.1% in LPTK patients after long segmental instrumented fusion. Preoperative hyperkyphosis and advanced fatty degeneration of paraspinal muscles were independent risk factors of junctional kyphosis. Patients with lower bone quality were more likely to develop junctional failure.

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Modified grade 4 osteotomy for kyphosis due to old osteoporotic vertebral compression fractures

Cited by 4 publications

References 14 publications

Surgical options for symptomatic old osteoporotic vertebral compression fractures: A retrospective study of 238 cases

Surgical options for symptomatic old osteoporotic vertebral compression fractures: A retrospective study of 238 cases

Distal Junctional Failures in Degenerative Thoracolumbar Hyperkyphosis

Junctional Kyphosis after Correction with Long Instrumentation for Late Posttraumatic Thoracolumbar Kyphosis: Characteristics and Risk Factors

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