Radiculopathy Caused by Osteoporotic Vertebral Fractures in the Lumbar Spine

Sasaki, Masaru; Aoki, Masanori; Nishioka, K; Yoshimine, Toshiki

doi:10.2176/nmc.51.484

Cited by 25 publications

(24 citation statements)

References 11 publications

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“…3A). In the flat-type (Type 2) and concave or H-shaped type (Type 3) low lumbar OVC, neurological symptoms result from retropulsed bony fragments causing foraminal stenosis and/or canal stenosis 8,19 ( Fig. 3B and C).…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience

Nakajima¹,

Uchida²,

Honjoh³

et al. 2016

SPI

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OBJECT Low lumbar osteoporotic vertebral collapse (OVC) has not been well documented compared with OVC of the thoracolumbar spine. The differences between low lumbar and thoracolumbar lesions should be studied to provide better treatment. The aim of this study was to clarify the clinical and imaging features as well as outcomes of low lumbar OVC and to discuss the appropriate surgical treatment. METHODS Thirty patients (10 men; 20 women; mean age 79.3 ± 4.7 years [range 70–88 years]) with low lumbar OVC affecting levels below L-3 underwent surgical treatment. The clinical symptoms, morphological features of affected vertebra, sagittal spinopelvic alignment, neurological status before and after surgery, and surgical procedures were reviewed at a mean follow-up period of 2.4 years. RESULTS The main clinical symptom was radicular leg pain. Most patients had old compression fractures at the thoracolumbar level. The affected vertebra was flat-type and concave or H-shaped type, not wedge type as often found in thoracolumbar OVC. There were mismatches between pelvic incidence and lumbar lordosis on plain radiographs. On CT and MR images, foraminal stenosis was seen in 18 patients (60%) and canal stenosis in 24 patients (80%). Decompression with short fusion using a posterior approach was performed. Augmentations of vertebroplasty, posterolateral fusion, and posterior lumbar interbody fusion were performed based on the presence/absence of local kyphosis of lumbar spine, cleft formation, and/or intervertebral instability. Although the neurological and visual analog scale scores improved postoperatively, 8 patients (26.7%) developed postoperative complications mainly related to instrumentation failure. In patients with postoperative complications, lumbar spine bone mineral density was significantly low, but the spinopelvic alignment showed no correlation when compared with those without complications. CONCLUSIONS The main types of low lumbar OVC were flat-type and concave type, which resulted in neurological symptoms by retropulsed bony fragments generating foraminal stenosis and/or canal stenosis. For patients with low lumbar OVC, decompression of the foraminal and canal stenosis with short fusion surgery via posterior approach can improve neurological symptoms. Since these patients are elderly with poor bone quality and other complications, treatments for both OVC and osteoporosis should be provided to achieve good clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience

Nakajima¹,

Uchida²,

Honjoh³

et al. 2016

SPI

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“…Many previous studies have reported the surgical techniques and outcomes of OVF with neurological deficits [6][7][8][9][10][11][12][13][14][15] . Most of these studies are case series at a single or small group of institutions, and studies with large sample sizes are scarce.…”

Section: Introductionmentioning

confidence: 99%

The Surgical Outcomes of Spinal Fusion for Osteoporotic Vertebral Fractures in the Lower Lumbar Spine with a Neurological Deficit

Isogai

Hosogane

Funao

et al. 2020

Spine Surg Relat Res

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“…[303132] This is due to the Spine Jack ® efficient mechanical characteristic, but above all it is due to the possibility of leaving the devices into the vertebral body. This avoids vertebral body recollapsing before cement injection[56] [Figure 8].…”

Section: Resultsmentioning

confidence: 99%

New perspective for third generation percutaneous vertebral augmentation procedures: Preliminary results at 12 months

Vanni

Pantalone

Bigossi³

et al. 2012

J Craniovert Jun Spine

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Introduction:The prevalence of osteoporotic vertebral fractures (OVF) increased in the last years. Compression fractures promote a progressive spine kyphosis increase, resulting in a weight shift and anterior column overload, with OVF additional risk (domino effect). The aim of this study is to evaluate the OVF treatment outcome using Spine Jack®, a titanium device for third generation percutaneous vertebral augmentation procedures (PVAPs).Materials and Methods:From February 2010, a prospective randomized study was performed examining 300 patients who underwent PVAP due to OVF type A1 according to Magerl/AO spine classification. Patients enrolled in the study were divided in two homogenous groups with regards to age (65-85 years), sex, and general clinical findings. Group A included 150 patients who underwent PVAP using Spine Jack® system; the second, group B (control group), included 150 patients treated by conventional balloon kyphoplasty. Patients underwent a clinical (visual analogue scale and Oswestry disability index) and radiographic follow-up, with post-operative standing plain radiogram of the spine at 1, 6, and 12 months. The radiographic parameters that were taken into account were: Post-operative anterior vertebral body height, pre-operative anterior vertebral body height, cephalic anterior vertebral body height, and caudal anterior vertebral body height.Results:Compared to the Spine Jack® group, the kyphoplasty group required a little longer operation time (an average of 40 min–group A vs. 45 min–group B, P < 0.05) and a greater amount of polymethylmethacrylate (4.0 mL–group A vs. 5.0 mL–group B, P < 0.05;). The post-operative increase in vertebral body height was greater in the Spine Jack® group than in the kyphoplasty group (P < 0.05).Discussion:PVAP are based on the cement injection into the vertebral body. Vertebroplasty does not allow the vertebral body height recovery. Balloon kyphoplasty allows a temporary height restoration. Spine Jack® has some new features compared to other systems: It is equipped with a mechanical and not a hydraulic opening control; this ensures a gradual and controlled vertebral fracture reduction.Conclusions:In our study, we demonstrated that the third generation PVAP with Spine Jack® is able to determine a safe vertebral body height restoration compared to the conventional balloon kyphoplasty.

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Radiculopathy Caused by Osteoporotic Vertebral Fractures in the Lumbar Spine

Cited by 25 publications

References 11 publications

Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience

Surgical treatment of low lumbar osteoporotic vertebral collapse: a single-institution experience

The Surgical Outcomes of Spinal Fusion for Osteoporotic Vertebral Fractures in the Lower Lumbar Spine with a Neurological Deficit

New perspective for third generation percutaneous vertebral augmentation procedures: Preliminary results at 12 months

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