Posterior-approach Vertebral Replacement With Rectangular Parallelepiped Cages (PAVREC) for the Treatment of Osteoporotic Vertebral Collapse With Neurological Deficits

Suzuki, Tetsuya; Abe, Eiji; Miyakoshi, Naohisa; Murai, Hajime; Kobayashi, Takashi; Abe, Tomoki; Kikuchi, Kazuma; Shimada, Yasuhiro

doi:10.1097/bsd.0b013e318286fc18

Cited by 21 publications

(13 citation statements)

References 26 publications

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“…March L et al reported that on the osteoporotic vertebral body, the peripheral regions of the endplate have greater resistance to subsidence, whereas the central region provides the least resistance9). So grafted autobone inside and around the wide cages (more than 22mm) is likely to be advantage for bony union due to adequate stress transmission and proper blood flow16). Although, grafted autobone itself is already changed weakly, which can help prevent to some degrees of cage subsidence16).…”

Section: Discussionmentioning

confidence: 99%

“…So grafted autobone inside and around the wide cages (more than 22mm) is likely to be advantage for bony union due to adequate stress transmission and proper blood flow16). Although, grafted autobone itself is already changed weakly, which can help prevent to some degrees of cage subsidence16). There are some possible causes for the formation of a pseudoarthrosis4).…”

Section: Discussionmentioning

confidence: 99%

“…Both nonoperative and operative treatments can be employed depending on the patient's age, comorbidities, and fracture stability13). Preoperative management of the injured spine with AS is difficult and technically challenging due to the osteoporotic changes, stiffness, and cage subsidence, in addition to pseudoarthrosis9,11,16).…”

Section: Introductionmentioning

confidence: 99%

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Surgical Treatment of Lumbar Hyperextension Injury in Ankylosing Spondylitis

Lee

Park

et al. 2013

Korean J Spine

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Ankylosing spondylitis (AS) is a chronic systemic and inflammatory rheumatic disease with a variable course of the axial skeleton. Spinal involvement may accompany ossification of the ligaments, intervertebral disc, end-plates and apophyseal structures, and seems to be "bamboo spine". Because of these natures of the spine in AS, a spinal fracture can be occurred with minor trauma or spontaneously. The fracture of the AS can cause neurological complications extremely high, so special attention to prevent neurological deterioration. Operative management of the injured spine with AS is difficult, and associated with a high complication rate. Extreme care must be taken for surgery to prevent secondary neurological deterioration.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical Treatment of Lumbar Hyperextension Injury in Ankylosing Spondylitis

Lee

Park

et al. 2013

Korean J Spine

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“…If the fractured vertebra was severely collapsed and showed decreased intravertebral instability, the vertebrae were partially or totally resected using a posterior approach and replaced with large, rectangular, parallelepiped cages and autograft bone and pedicle screwing was then applied 1–3 levels above and below the lesion, considering the affected vertebral level and osteoporosis severity [ 9 ]. This technique was termed “posterior approach vertebral replacement with rectangular parallelepiped cage” (PAVREC) [ 9 ]. The details of the PAVREC procedure have been described elsewhere [ 9 ].…”

Section: Methodsmentioning

confidence: 99%

Perioperative Medical Complications after Posterior Approach Spinal Instrumentation Surgery for Osteoporotic Vertebral Collapse: A Comparative Study in Patients with Primary Osteoporosis and Those with Secondary Osteoporosis

Miyakoshi

Kobayashi²,

Suzuki³

et al. 2017

Asian Spine J

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Study DesignA retrospective comparative study.PurposeTo compare perioperative medical complications after posterior approach spinal instrumentation surgery for osteoporotic vertebral collapse (OVC) between patients with primary osteoporosis and those with secondary osteoporosis.Overview of LiteratureWith increased aging of society, the demand for instrumentation surgery for an osteoporotic spine has been increasing. However, no studies have compared the rates or severities of perioperative complications after spinal instrumentation surgery between patients with primary osteoporosis and those with secondary osteoporosis.MethodsNinety-one patients with OVC aged ≥50 years (23 males and 68 females) who underwent posterior approach vertebral replacement with cages or posterior spinal fusion combined with vertebroplasty were divided into primary (n=56) and secondary (n=35) osteoporosis groups. Bone mineral density (BMD), osteoporosis treatment prior to OVC, operative invasiveness, and perioperative medical complications were compared.ResultsDiabetes mellitus (51.4%) was the most common cause of secondary osteoporosis, followed by glucocorticoid use (22.9%). No significant differences were seen in terms of age, gender, BMD, osteoporosis treatment, or operative invasiveness, including the number of levels fused, estimated blood loss, and number of patients requiring transfusion. No significant difference in the incidence of perioperative complications were observed between the primary and secondary osteoporosis groups (16.1% vs. 22.9%). However, surgical site infection (SSI) was significantly more frequently seen in the secondary osteoporosis group (11.4%) than in the primary osteoporosis group (1.8%; p<0.05). One patient in the secondary osteoporosis group developed methicillin-resistant Staphylococcus aureus infection that ultimately required instrument removal.ConclusionsThe overall incidence of perioperative medical complications after posterior approach spinal instrumentation surgery for OVC was comparable between the primary and secondary osteoporosis groups under conditions of similar background characteristics and operative invasiveness. However, SSI (particularly more severe cases) occurred more frequently in patients with secondary osteoporosis.

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“…However, in some patients with severely collapsed vertebrae, the vertebrae were partially resected and replaced with large, rectangular, parallelepiped cages (REC cages) and autograft bone. This technique is a modification of the PLIF technique and was termed Bposterior-approach vertebral replacement with REC cages( PAVREC) [15]. PAVREC was applied as a part of spinal correction combined with multilevel PLIF.…”

Section: Corrective Spinal Surgerymentioning

confidence: 99%

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

et al. 2015

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This study evaluated changes in spinal alignment and quality of life (QOL) after corrective spinal surgery for patients with postmenopausal osteoporosis and spinal kyphosis. Spinal global alignment and QOL were significantly improved after corrective spinal surgery but did not reach the level of non-operated controls. Introduction With the increased aging of society, the demand for corrective spinal instrumentation for spinal kyphosis in osteoporotic patients is increasing. However, previous studies have not focused on the improvement of quality of life (QOL) after corrective spinal surgery in patients with osteoporosis, compared to non-operated control patients. The purposes of this study were thus to evaluate changes in spinal alignment and QOL after corrective spinal instrumentation for patients with osteoporosis and spinal kyphosis and to compare these results with non-operated patients. Methods Participants comprised 39 patients with postmenopausal osteoporosis ≥50 years old who underwent corrective spinal surgery using multilevel posterior lumbar interbody fusion (PLIF) for symptomatic thoracolumbar or lumbar kyphosis, and 82 age-matched patients with postmenopausal osteoporosis without prevalent vertebral fractures. Spinopelvic parameters were evaluated with standing lateral spine radiography, and QOL was evaluated with the Japanese Osteoporosis QOL Questionnaire (JOQOL), SF-36, and Roland-Morris Disability Questionnaire (RDQ). Results Lumbar kyphosis angle, sagittal vertical axis, and pelvic tilt were significantly improved postoperatively. QOL evaluated with all three questionnaires also significantly improved after 6 months postoperatively, particularly in domain and subscale scores for pain and general/mental health. However, these radiographic parameters, total JOQOL score, SF-36 physical component summary score, and RDQ score were significantly inferior compared with non-operated controls. ConclusionsThe results indicate that spinal global alignment and QOL were significantly improved after corrective spinal surgery using multilevel PLIF for patients with osteoporosis and spinal kyphosis but did not reach the level of non-operated controls.

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Posterior-approach Vertebral Replacement With Rectangular Parallelepiped Cages (PAVREC) for the Treatment of Osteoporotic Vertebral Collapse With Neurological Deficits

Abstract: PAVREC provided a satisfactory clinical and radiologic outcome without severe complications. This procedure can be a treatment option for osteoporotic vertebral collapse and an alternative to an anterior-approach or single posterior-approach reconstruction with a cylindrical cage.

Cited by 21 publications

References 26 publications

Surgical Treatment of Lumbar Hyperextension Injury in Ankylosing Spondylitis

Surgical Treatment of Lumbar Hyperextension Injury in Ankylosing Spondylitis

Perioperative Medical Complications after Posterior Approach Spinal Instrumentation Surgery for Osteoporotic Vertebral Collapse: A Comparative Study in Patients with Primary Osteoporosis and Those with Secondary Osteoporosis

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

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