Vertebroplasty-augmented short-segment posterior fixation of osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine: comparisons with posterior surgery without vertebroplasty and anterior surgery

Uchida, Kenzo; Nakajima, Hideaki; Yayama, Takafumi; Miyazaki, Tsuyoshi; Hirai, Takayuki; Kobayashi, Shigeru; Chen, Kebing; Guerrero, Alexander Rodríguez; Baba, H.

doi:10.3171/2010.5.spine09813

Cited by 83 publications

(80 citation statements)

References 41 publications

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“…In our previous study on thoracolumbar OVC, we reported that VP-augmented short-segment fixation seems to offer immediate spinal stability, and the effect seemed equivalent to that of anterior reconstruction. 26,28 Similar to low lumbar OVC, VP is available for the stability of the collapsed vertebra. However, VP without short fusion (only VP) is not recommended because the load on middle and/or posterior lesions of the affected vertebra increased in this group, and collapse of the affected vertebra could easily progress.…”

Section: Discussionmentioning

confidence: 99%

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

Nakajima¹,

Uchida²,

Honjoh³

et al. 2016

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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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“…In accordance with this theory, several types of surgical decompression and fusion through either an anterior and/or posterior approach have been performed [1,12,15,19,26,31,34,37]. However, some authors have reported that conservative treatment could provide reliable neurologic improvement.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit

et al. 2013

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Introduction The number of cases of osteoporotic vertebral compression fracture (OVCF) with intravertebral cleft (IVC) with delayed neurologic deficit (DND) is increasing as the population ages. However, the cause of DND is poorly understood, and no definitive treatment of the disease has been established. The purpose of this study was to clarify the radiographic parameters contributing to the occurrence of DND, and to evaluate the efficacy and safety of percutaneous vertebroplasty for this pathology. Methods Percutaneous vertebroplasty was prospectively performed for 244 patients with OVCF with IVC; 30 had DND and 214 did not. Radiographic parameters of local kyphotic angle, percent spinal canal compromise and intravertebral instability were investigated for correlations to DND. Procedural outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and modified Frankel grades. Results Before vertebroplasty, no substantial difference in local kyphotic angle was seen between OVCF with IVC with and without DND, but percent spinal canal compromise and intravertebral instability were greater in OVCF with IVC with DND (P \ 0.001). After vertebroplasty, 25 of 30 cases (84 %) of OVCF with IVC with DND achieved clinically meaningful improvement (CMI), but 5 (17 %) did not. Patients with CMI showed substantial improvements in intravertebral instability (P \ 0.001), and no change in local kyphotic angle or percent spinal canal compromise. In five patients without CMI, four showed an initial improvement, but subsequent vertebral fracture adjacent to the treated vertebra caused neurologic re-deterioration. One patient with percent spinal canal compromise 54.9 % and intravertebral instability 4°achieved no neurologic improvement following vertebroplasty. No serious complications or adverse events related to the procedure were encountered. ConclusionsIntravertebral instability is the dominant cause of DND. Percutaneous vertebroplasty appears effective and safe in the treatment of OVCF with IVC with DND. Patients with less intravertebral instability and severe spinal canal compromise could be candidates for conventional surgical treatment.

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“…The results of percutaneous vertebral body augmentation in osteoporotic compression fractures (OCF) without trauma has encouraged surgeons to extend the indications and use these techniques to restore anterior column even in traumatic fractures as stand-alone intervention or in combination with posterior instrumentation [9,10,14-16,20,21,34,36]. …”

Section: Discussionmentioning

confidence: 99%

“…Clinical investigations describe a higher risk of instrument failure in short segment instrumentation with increased preoperative kyphotic deformity in osteoporotic patients [21]. VP is considered to increase spinal stability in patients with thoracolumbar burst fractures, to decreases the instrument failure rate, and to improve postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical evaluation of combined short segment fixation and augmentation of incomplete osteoporotic burst fractures

Hartensuer

Gehweiler

Schulze

et al. 2013

BMC Musculoskelet Disord

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BackgroundTreating traumatic fractures in osteoporosis is challenging. Multiple clinical treatment options are found in literature. Augmentation techniques are promising to reduce treatment-related morbidity. In recent years, there have been an increasing number of reports about extended indication for augmentation techniques. However, biomechanical evaluations of these techniques are limited.MethodsNine thoracolumbar osteoporotic spinal samples (4 FSU) were harvested from postmortem donors and immediately frozen. Biomechanical testing was performed by a robotic-based spine tester. Standardized incomplete burst fractures were created by a combination of osteotomy-like weakening and high velocity compression using a hydraulic material testing apparatus. Biomechanical measurements were performed on specimens in the following conditions: 1) intact, 2) fractured, 3) bisegmental instrumented, 4) bisegmental instrumented with vertebroplasty (hybrid augmentation, HA) and 5) stand-alone vertebroplasty (VP). The range of motion (RoM), neutral zone (NZ), elastic zone (EZ) and stiffness parameters were determined. Statistical evaluation was performed using Wilcoxon signed-rank test for paired samples (p = 0.05).ResultsSignificant increases in RoM and in the NZ and EZ (p < 0.005) were observed after fracture production. The RoM was decreased significantly by applying the dorsal bisegmental instrumentation to the fractured specimens (p < 0.005). VP reduced fractured RoM in flexion but was still increased significantly (p < 0.05) above intact kinematic values. NZ stiffness (p < 0.05) and EZ stiffness (p < 0.01) was increased by VP but remained lower than prefracture values. The combination of short segment instrumentation and vertebroplasty (HA) showed no significant changes in RoM and stiffness in NZ in comparison to the instrumented group, except for significant increase of EZ stiffness in flexion (p < 0.05).ConclusionsStand-alone vertebroplasty (VP) showed some degree of support of the anterior column but was accompanied by persistent traumatic instability. Therefore, we would advocate against using VP as a stand-alone procedure in traumatic fractures.HA did not increase primary stability of short segment instrumentation. Some additional support of anterior column and changes of kinematic values of the EZ may lead one to suppose that additive augmentation may reduce the load of dorsal implants and possibly reduce the risk of implant failure.

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Vertebroplasty-augmented short-segment posterior fixation of osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine: comparisons with posterior surgery without vertebroplasty and anterior surgery

Cited by 83 publications

References 41 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

Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit

Biomechanical evaluation of combined short segment fixation and augmentation of incomplete osteoporotic burst fractures

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