Anterior versus posterior surgery for osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine

Object The surgical approach and treatment of thoracolumbar osteoporotic vertebral collapse with neurological deficit have not been documented in detail. Anterior surgery provides good decompression and solid fusion, but the surgery-related risk is relatively higher than that associated with the posterior approach. In posterior surgery, the major problem after posterior correction and instrumentation is failure to support the anterior spinal column, leading to loss of correction of kyphosis. The aim of this study was to evaluate the efficacy of reinforcing short-segment posterior fixation with vertebroplasty and to compare the outcome with those of posterior surgery without vertebroplasty and anterior surgery, retrospectively. Methods The authors studied 83 patients who underwent surgical treatment for a single thoracolumbar osteoporotic vertebral collapse with neurological deficit. Twenty-eight patients treated by posterior surgery combined with vertebroplasty (Group A), 25 patients treated by posterior surgery without vertebroplasty (Group B), and 30 patients treated by anterior surgery (Group C) were followed up for a mean postoperative period of 4.4 years. Neurological outcome, visual analog scale pain score, and radiographic results were compared in the 3 groups. Results Postoperative (4–6 weeks) and follow-up neurological outcome and visual analog scale scores were not significantly different among the 3 groups. Postoperative kyphotic angle was significantly reduced in Group B compared with Group C (p = 0.007), whereas the kyphotic angle was not significantly different among the 3 groups at follow-up. The mean ± SD loss of correction at follow-up was 4.6° ± 4.5°, 8.6° ± 6.2°, and 4.5° ± 5.9° in Groups A, B, and C, respectively. The correction loss at follow-up in Group B was significantly higher compared with Groups A and C (p = 0.0171 and p = 0.0180, respectively). Conclusions The results suggest that additional reinforcement with vertebroplasty reduces the kyphotic loss and instrumentation failure, compared with patients without the reinforcement of vertebroplasty. Vertebroplasty-augmented short-segment fixation seems to offer immediate spinal stability in patients with thoracolumbar osteoporotic vertebral collapse; the effect seems equivalent to that of anterior reconstruction.

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Short- versus long-segment posterior spinal fusion with vertebroplasty for osteoporotic vertebral collapse with neurological impairment in thoracolumbar spine: a multicenter study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03539-0 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Yuya Ishikawa ◽

Kei Watanabe ◽

Keiichi Katsumi ◽

Masayuki Ohashi ◽

Yohei Shibuya ◽

...

Keyword(s):

Spinal Fusion ◽

Multicenter Study ◽

Thoracolumbar Spine ◽

Posterior Spinal Fusion ◽

Neurological Impairment ◽

Vertebral Collapse ◽

Osteoporotic Vertebral Collapse

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Predictors of Recovery After Conservative Treatment of AO-Type A Thoracolumbar Spine Fractures Without Neurological Deficit

Spine ◽

10.1097/brs.0b013e3181cdb5fc ◽

2018 ◽

Vol 43 (2) ◽

pp. 141-147 ◽

Cited By ~ 2

Author(s):

Peter Vorlat ◽

Geert Leirs ◽

Farhad Tajdar ◽

Heinz Hulsmans ◽

Hugo De Boeck ◽

...

Keyword(s):

Conservative Treatment ◽

Neurological Deficit ◽

Thoracolumbar Spine ◽

Type A ◽

Spine Fractures ◽

Thoracolumbar Spine Fractures

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Minimally invasive anteroposterior combined surgery using lateral lumbar interbody fusion without corpectomy for treatment of lumbar spinal canal stenosis associated with osteoporotic vertebral collapse

Journal of Neurosurgery Spine ◽

10.3171/2020.10.spine201293 ◽

2021 ◽

pp. 1-9

Author(s):

Kentaro Fukuda ◽

Hiroyuki Katoh ◽

Yuichiro Takahashi ◽

Kazuya Kitamura ◽

Daiki Ikeda

Keyword(s):

Interbody Fusion ◽

Combined Surgery ◽

Vertebral Collapse ◽

Short Segment ◽

Canal Stenosis ◽

The Mean ◽

Osteoporotic Vertebral Collapse ◽

Anterior Support ◽

Lumbar Spinal

OBJECTIVE Various reconstructive surgical procedures have been described for lumbar spinal canal stenosis (LSCS) with osteoporotic vertebral collapse (OVC); however, the optimal surgery remains controversial. In this study, the authors aimed to report the clinical and radiographic outcomes of their novel, less invasive, short-segment anteroposterior combined surgery (APCS) that utilized oblique lateral interbody fusion (OLIF) and posterior fusion without corpectomy to achieve decompression and reconstruction of anterior support in patients with LSCS-OVC. METHODS In this retrospective study, 20 patients with LSCS-OVC (mean age 79.6 years) underwent APCS and received follow-up for a mean of 38.6 months. All patients were unable to walk without support owing to severe low-back and leg pain. Cleft formations in the fractured vertebrae were identified on CT. APCS was performed on the basis of a novel classification of OVC into three types. In type A fractures with a collapsed rostral endplate, combined monosegment OLIF and posterior spinal fusion (PSF) were performed between the collapsed and rostral adjacent vertebrae. In type B fractures with a collapsed caudal endplate, combined monosegment OLIF and PSF were performed between the collapsed and caudal adjacent vertebrae. In type C fractures with severe collapse of both the rostral and caudal endplates, bisegment OLIF and PSF were performed between the rostral and caudal adjacent vertebrae, and pedicle screws were also inserted into the collapsed vertebra. Preoperative and postoperative clinical and radiographical status were reviewed. RESULTS The mean number of fusion segments was 1.6. Walking ability improved in all patients, and the mean Japanese Orthopaedic Association score for recovery rate was 65.7%. At 1 year postoperatively, the mean preoperative Oswestry Disability Index of 65.6% had significantly improved to 21.1%. The mean local lordotic angle, which was −5.9° preoperatively, was corrected to 10.5° with surgery and was maintained at 7.7° at the final follow-up. The mean corrective angle was 16.4°, and the mean correction loss was 2.8°. CONCLUSIONS The authors have proposed using minimally invasive, short-segment APCS with OLIF, tailored to the morphology of the collapsed vertebra, to treat LSCS-OVC. APCS achieves neural decompression, reconstruction of anterior support, and correction of local alignment.

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THORACOLUMBAR SPINAL ARTHRODESIS - EPIDEMIOLOGY AND COSTS

Coluna/Columna ◽

10.1590/s1808-185120171601162774 ◽

2017 ◽

Vol 16 (1) ◽

pp. 52-55

Author(s):

TOBIAS LUDWIG DO NASCIMENTO ◽

LUIZ PEDRO WILLIMANN ROGÉRIO ◽

MARCELO MARTINS DOS REIS ◽

LEANDRO PELEGRINI DE ALMEIDA ◽

GUILHERME FINGER ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Neurological Deficit ◽

Traffic Accidents ◽

Thoracolumbar Spine ◽

Hospital Costs ◽

Spine Fracture ◽

Female Ratio ◽

Cord Injury ◽

Fall From Height

ABSTRACT Objective: To describe the epidemiology of patients with thoracolumbar spine fracture submitted to surgery at Hospital Cristo Redentor and the related costs. Methods: Prospective epidemiological study between July 2014 and August 2015 of patients with thoracolumbar spine fracture with indication of surgery. The variables analyzed were sex, age, cost of hospitalization, fractured levels, levels of arthrodesis, surgical site infection, UTI or BCP, spinal cord injury, etiology, length of stay, procedure time, and visual analog scale (VAS) . Results: Thirty-two patients were evaluated in the study period, with a mean age of 38.68 years. Male-female ratio was 4:1 and the most frequent causes were fall from height (46.87%) and traffic accidents (46.87%). The thoracolumbar transition was the most affected (40.62%), with L1 vertebra involved in 23.8% of the time. Neurological deficit was present in 40.62% of patients. Hospital stay had a median of 14 days and patients with neurological deficit were hospitalized for a longer period (p<0.001), with an increase in hospital costs (p= 0.015). The average cost of hospitalization was U$2,874.80. The presence of BCP increased the cost of hospitalization, and patients with spinal cord injury had more BCP (p= 0.014) . Conclusion: Public policies with an emphasis on reducing traffic accidents and falls can help reduce the incidence of these injuries and studies focusing on hospital costs and rehabilitation need to be conducted in Brazil to determinate the burden of spinal trauma and spinal cord injury.

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Short vs long posterior fixation of thoracolumbar spine injuries

Medicinski pregled ◽

10.2298/mpns16s1015s ◽

2016 ◽

Vol 69 (suppl. 1) ◽

pp. 15-21

Author(s):

Milan Stankovic ◽

Natasa Janjic ◽

Ivica Lalic ◽

Nemanja Gvozdenovic ◽

Igor Elez ◽

...

Keyword(s):

Orthopedic Surgery ◽

Neurological Deficit ◽

Anterior Part ◽

Thoracolumbar Spine ◽

Posterior Fixation ◽

Low Back ◽

Fixation Group ◽

Clinical Center ◽

Spine Injuries

Introduction. More than a quarter of total number of posterior fixations of thoracolumbar spine is unsuccessful. Material and methods. The aim is to compare short and long fixation of thoracolumbar spine injuries. During the period of 2006 to 2015 we examined 99 patients at the Department of Orthopedic Surgery and Traumatology of Clinical Center of Vojvodina. Short fixation was performed in 63 cases and long fixation in 36 cases. All patients underwent clinical, radiographic and neurological evaluation. Mean age in the short fixation group was 47 (18-66) and in the long fixation group it was 43 (17-70). Mean follow-up time was 4,5 years. Results. Implants were extracted in 14 cases of short and in 4 cases of long fixation. Collapse of anterior part of vertebral body developed in 28,45% in the short fixation group and in 22,43% in the long fixation group whereas angulation value was 10,2o and 12,3o respectively. Mean low back outcome scale value was 61 points in the short fixation group and 50 in the long fixation group. There were 22 patients with neurological deficit. Full recovery was recorded in 8 patients (36,4%) of the short fixation group and in 17 patients (22,7%) of the long fixation group. Complications developed in 15 patients (23,8%) of the short fixation group and 11 (30,6%) of the long fixation group. Conclusion. Short fixation is biomechanically weaker but provides a better functional recovery than long fixation.

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