Kyphosis and canal compromise due to refracturing of an L1 cemented vertebra managed with posterior surgery alone

Background: An already cemented vertebral body rarely refractures and its occurrence may be signaled by the reappearance of pain and/or significant vertebral collapse/kyphosis resulting in canal compromise and neurological deterioration. Case Description: An 81-year-old male originally underwent an L1 kyphoplasty for an osteoporotic compression fracture. Nine months later, he presented with the late onset of recurrent collapse of the cemented vertebral body, leading to pain, kyphosis, and canal compromise. Surgery warranted total L1 corpectomy, reconstruction of the anterior column, and a posterior fixation through a purely posterior approach (posterior vertebral column resection [pVCR]). Conclusion: Here, we presented the safety/efficacy of utilizing a purely posterior approach (e.g., including L1 corpectomy, reconstruction of the anterior column, and posterior fusion: pVCR) in the management of a repeated fracture of a cemented L1 vertebra resulting in kyphosis and canal compromise.

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Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-018-0979-7 ◽

2018 ◽

Vol 13 (1) ◽

Author(s):

Wenbin Hua ◽

Xinghuo Wu ◽

Yukun Zhang ◽

Yong Gao ◽

Shuai Li ◽

...

Keyword(s):

Risk Factors ◽

Vertebral Column ◽

Late Onset ◽

Case Series ◽

Neurological Complications ◽

Neurological Deficits ◽

Review Of The Literature ◽

Vertebral Column Resection ◽

Posterior Vertebral Column Resection

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Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes

Global Spine Journal ◽

10.1177/2192568220964453 ◽

2020 ◽

pp. 219256822096445

Author(s):

Azmi Hamzaoglu ◽

Mustafa Elsadig ◽

Selhan Karadereler ◽

Ayhan Mutlu ◽

Yunus Emre Akman ◽

...

Keyword(s):

Neurological Deficit ◽

Vertebral Column ◽

Single Stage ◽

Anterior Column ◽

Vertebral Column Resection ◽

Posterior Vertebral Column Resection ◽

Thoracolumbar Burst Fractures ◽

Burst Fractures ◽

The Mean

Study Design: Retrospective study. Objective: The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. Results: The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.

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Thoracolumbar Vertebral Column Resection With Rectangular Endplate Cages Through a Posterior Approach: Surgical Techniques and Early Postoperative Outcomes

Operative Neurosurgery ◽

10.1093/ons/opz151 ◽

2019 ◽

Cited By ~ 1

Author(s):

Michael M Safaee ◽

Murat Pekmezci ◽

Vedat Deviren ◽

Christopher P Ames ◽

Aaron J Clark

Keyword(s):

Vertebral Column ◽

Posterior Approach ◽

Surgical Techniques ◽

Postoperative Outcomes ◽

Vertebral Column Resection

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Using the cortical bone trajectory screw technique with vertebral column resection to treat an osteoporotic compression fracture in progressive thoracolumbar hyperkyphosis: A case report

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2018.10.008 ◽

2019 ◽

Vol 15 ◽

pp. 98-100

Author(s):

Chia-Hung Chao ◽

Cheng-Yang Hsieh ◽

Yu-Feng Su ◽

Aij-Lie Kwan

Keyword(s):

Case Report ◽

Cortical Bone ◽

Vertebral Column ◽

Compression Fracture ◽

Vertebral Column Resection ◽

Cortical Bone Trajectory ◽

Osteoporotic Compression Fracture

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MRI PATTERN OF VERTEBRAL FRACTURES DUE TO OSTEOPOROSIS, INFECTION, AND MALIGNANT TUMORS

Journal of Musculoskeletal Research ◽

10.1142/s0218957710002491 ◽

2010 ◽

Vol 13 (02) ◽

pp. 57-63

Author(s):

Mohamed El-Sayed Abdel-Wanis ◽

Mohamed Tharwat Mahmoud Solyman ◽

Nahla Mohamed Ali Hasan

Keyword(s):

Vertebral Body ◽

Vertebral Fractures ◽

Malignant Tumors ◽

Compression Fracture ◽

Osteoporotic Fractures ◽

Spinal Infection ◽

Vertebral Compression Fractures ◽

Vertebral Collapse ◽

Compression Fractures ◽

Vertebral Wedging

No previous studies discussed the significance of the MRI pattern of vertebral collapse in differentiation between vertebral compression fractures due to malignancy, osteoporosis, and infections. MRI was used in the evaluation of 152 atraumatic vertebral compression fractures in 80 patients: 85 malignant, 34 osteoporotic, and 33 infective. Central collapse of the fractured vertebral body was the commonest pattern in malignant fractures (57 vertebrae, 67%), followed by uniform collapse (21 vertebrae, 24.7%), then anterior wedging (5 vertebrae, 5.9%), and finally posterior wedging (2 vertebrae, 2.4%). In osteoporotic fractures, anterior wedging was the commonest pattern (18 vertebrae, 53%), followed by central collapse (11 vertebrae, 32.3%), then uniform collapse (4 vertebrae, 11.8%), and finally posterior wedging (1 vertebra, 2.9%). In vertebral compression fractures due to spinal infection, anterior wedging was the commonest pattern (20 vertebrae, 60.6%), followed by uniform collapse (12 vertebrae, 36.4%), while only one vertebra (3%) was centrally collapsed. Central collapse of the vertebral body is highly suggestive of malignant compression fracture while anterior vertebral wedging is highly suggestive of a benign compression fracture.

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Biomechanical finite element analysis of vertebral column resection and posterior unilateral vertebral resection and reconstruction osteotomy

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02237-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ye Han ◽

Xiaodong Wang ◽

Jincheng Wu ◽

Hanpeng Xu ◽

Zepei Zhang ◽

...

Keyword(s):

Internal Fixation ◽

Vertebral Body ◽

Vertebral Column ◽

Vertebral Compression Fractures ◽

Lateral Bending ◽

Short Segment ◽

Vertebral Column Resection ◽

Compression Fractures ◽

Short Segment Fixation ◽

Vertebral Resection

Abstract Background Regarding the repair of vertebral compression fractures, there is a lack of adequate biomechanical verification as to whether only half of the vertebral body and the upper and lower intervertebral discs affect spinal biomechanics; there also remains debate as to the appropriate length of fixation. Methods A model of old vertebral compression fractures with kyphosis was established based on CT data. Vertebral column resection (VCR) and posterior unilateral vertebral resection and reconstruction (PUVCR) were performed at T12; long- and short-segment fixation methods were applied, and we analyzed biomechanical changes after surgery. Results Range of motion (ROM) decreased in all fixed models, with lumbar VCR decreasing the most and short posterior unilateral vertebral resection and reconstruction (SPUVCR) decreasing the least; in the long posterior unilateral vertebral resection and reconstruction (LPUVCR) model, the internal fixation system produced the maximum VMS stress of 213.25 mPa in a lateral bending motion and minimum stress of 40.22 mPa in a lateral bending motion in the SVCR. Conclusion There was little difference in thoracolumbar ROM between PUVCR and VCR models, while thoracolumbar ROM was smaller in long-segment fixation than in short-segment fixation. In all models, the VMS was most significant at the screw-rod junction and greatest at the ribcage–vertebral body interface, partly explaining the high probability of internal fixation failure and prosthesis migration in these two positions.

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