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

2010 ◽  
Vol 13 (5) ◽  
pp. 612-621 ◽  
Author(s):  
Kenzo Uchida ◽  
Hideaki Nakajima ◽  
Takafumi Yayama ◽  
Tsuyoshi Miyazaki ◽  
Takayuki Hirai ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Posterior Fixation ◽  
Vertebral Collapse ◽  
Kyphotic Angle ◽  
Short Segment ◽  
Anterior Surgery ◽  
Posterior Surgery ◽  
Group B ◽  
Osteoporotic Vertebral Collapse

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.

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

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.

scholarly journals Comparative study of long segment versus short segment posterior fixation of thoracolumbar fractures with pedicle screws

2021 ◽  
Vol 9 (2) ◽  
pp. 77-84
Author(s):  
Vihar SJ ◽  
Naveen DS ◽  
Agrawal NK
Keyword(s):  
Pedicle Screws ◽  
Posterior Fixation ◽  
Rigid Fixation ◽  
Thoracolumbar Fractures ◽  
Kyphotic Angle ◽  
Short Segment ◽  
Duration Of Surgery ◽  
One Year ◽  
Short Segment Fixation

Choice of long or short segment fixation for thoracolumbar fractures, benefits of either of these techniques has been a topic for analysis and assessment. Kyphotic angles in twenty patients diagnosed to have thoracolumbar vertebral fractures between December 2019 to December 2020 in Bapuji hospital and Chigateri general hospital, Davanagere, Karnataka, India were measured pre operatively, post operatively and at one year follow up and assessed. No statistical difference between the degrees of correction of initial kyphotic angle between long segment fixation and short segment posterior fixation in our study was found (p<0.6). Method of fixation of the thoracolumbar vertebral fracture did not correlate with initial degree of kyphosis (p=0.4). Amount of correction loss at one year follow up was found to be statistically significant in short segment fixation (p<0.05). Loss of kyphotic angle at one year follow up was higher in case of short segment fixation than long segment fixation and found to be statistically significant (p<0.005). Our study showed that long segment fixation helps in better correction of the kyphosis angle with lesser chance of loss of correction and can be opted when pedicles aren’t intact at the fracture level, as in cases of burst fractures. Short segment fixation provides better rigid fixation at the site of fracture with increased range of motion at the thoracolumbar segment and can be treatment of choice when the pedicles at the fractured level are intact, as in cases of compression fractures, having benefits of shorter duration of surgery and reduced risks.

scholarly journals A comparison of monoaxial and polyaxial pedicle screws in thoracolumbar fracture

2020 ◽  
Author(s):  
Wenye Yao ◽  
Runsheng Guo ◽  
Qi Lai ◽  
Banglin Xie ◽  
Zhi Yi ◽  
...  
Keyword(s):  
Pedicle Screws ◽  
Thoracolumbar Fracture ◽  
Posterior Fixation ◽  
Vertebral Endplate ◽  
Short Segment ◽  
Thoracolumbar Injury ◽  
Group A ◽  
Group B ◽  
Fracture Level

Abstract Purpose: To evaluate the use of short-segment posterior fixation with monoaxial and polyaxial pedicle screws in thoracolumbar fractures Methods: All patients who underwent short-segment posterior fixation with monoaxial pedicle screws or polyaxial pedicle screws in the injured vertebra of a thoracolumbar fracture (T12-L2) in our hospital between June 2012 and December 2018 were categorised into two groups: monoaxial pedicle screws group (group A) and polyaxial pedicle screws group (group B). We compared the Thoracolumbar Injury Severity Score (TLISS), American Spinal Injury Association (ASIA) score, the fracture level, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, hospital stay, injury-to-operation interval, and associated injuries between the two groups. In addition, the prevertebral height ratio, the injured vertebra Cobb angle, and the injured vertebral endplate centre ratio were measured preoperatively, postoperatively, and at the final follow-up. Results: There were 63 patients (21 males and 42 females) with an average age of 44.7 years. Compared with group B, the injury vertebral endplate centre ratio significantly increased postoperatively and at the final follow-up (P<0.05) in group A. Conclusion: Short-segment posterior fixation with monoaxial or polyaxial pedicle screws via the fracture level for thoracolumbar fracture can achieve kyphosis correction, reduce sagittal alignment correction failure, and maintain anterior vertebral height. The insertion of monoaxial pedicle screws at the fracture level after thoracolumbar vertebral fracture has a flick up effect on the central vertebral body of the injured vertebrae, which is beneficial to the recovery of the vertebral endplate.

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

2006 ◽  
Vol 15 (12) ◽  
pp. 1759-1767 ◽  
Author(s):  
Kenzo Uchida ◽  
Shigeru Kobayashi ◽  
Masahiko Matsuzaki ◽  
Hideaki Nakajima ◽  
Seiichiro Shimada ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Thoracolumbar Spine ◽  
Vertebral Collapse ◽  
Posterior Surgery ◽  
Osteoporotic Vertebral Collapse

scholarly journals Short vs long posterior fixation of thoracolumbar spine injuries

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.

scholarly journals Outcome of Unstable Thoracolumbar Fracture Following Long Segment Posterior Fixation

2021 ◽  
Vol 39 (2) ◽  
pp. 114-122
Author(s):  
Abdullah Al Mamun Choudhury ◽  
Md Shah Alam ◽  
Abul Kalam Azad ◽  
Kohinoor Akhter
Keyword(s):  
Functional Outcome ◽  
Neurological Deficit ◽  
Thoracolumbar Spine ◽  
Case Series ◽  
Fusion Rate ◽  
Spine Injury ◽  
P Value ◽  
Posterior Fixation ◽  
Thoracolumbar Region

Introduction: Fractures of the thoracolumbar region are the most common injuries of the vertebral column and burst fractures are the most frequent. The purpose of this study was to see the radiological and functional outcome after long segment posterior fixation in unstable thoracolumbar spine injury with incomplete neurological deficit. Methods: A total of 146 cases were included in this prospective case series from January 2014 to December 2018 through non randomized purposive sampling. All the patients were operated with long segment posterior fixation and postero-lateral fusion by Autogenous cancellous bone graft. Postoperative functional outcome was assessed both clinically by ODI, VAS, ASIA and radiologically by Bridwell criteria. Postoperative follow up was conducted at 2nd, 6th,12th and finally 6 monthly. Results: The mean Cobb angle at pre-operative was 21.5 ±8.9 and at final follow-up was 11±4.57 in this study (p-value<0.05). At final follow up 1 grade improvement occurred in 116(79.5%) patients and 2 grade improvement in 36 (20.5%). Regarding ODI and VAS, moderate disability (25%) with mild pain (16%) was found at final follow up with a Bridwell fusion grade II (48%). Conclusion: Long segment transpedicular screw fixation in unstable thoracolumbar spine injury with incomplete neurological deficit is an effective method of treatment. This method enhances neurological and functional recovery with an acceptable fusion rate J Bangladesh Coll Phys Surg 2021; 39(2): 114-122

scholarly journals Posterior Instrumentation for Unstable Thoracolumbar Fractures

2018 ◽  
Vol 6 (4) ◽  
pp. 150-155
Author(s):  
Bimal Kumar Pandey ◽  
Anjana Rajbhandari
Keyword(s):  
Posterior Instrumentation ◽  
Thoracolumbar Fractures ◽  
Type B ◽  
Vertebral Height ◽  
Kyphotic Angle ◽  
Short Segment ◽  
Medical College ◽  
Loss Of Correction ◽  
Type C

Background: About 90 percent of all spinal injuries involve the thoracolumbar region. Unstable fractures need surgical treatment to achieve a painless, balanced and stable spine preserving or recovering neurological function, highest degree of spinal motion and to allow early patient mobilization.Objective: This study was carried out to evaluate radiological outcome of posterior instrumentation in thoracolumbar fractures.Methodology: A total of 110 patients with thoracolumbar fracture were included in the study, which was carried out at Kathmandu Medical College Teaching Hospital from December 2011 to December 2016. Unstable Arbeitsgemeinschaft fur Osteosynthesefragen type A and type B fractures were treated with short segment instrumentation and type C with long segment instrumentation. Radiological evaluation of postoperative correction of kyphotic angle and vertebral height was measured and was compared with immediate postoperative correction and loss of correction in two years final follow up.Results: Mean postoperative correction of vertebral kyphotic angle was 25° and loss of correction in final follow up was 5°. Mean postoperative vertebral height correction was 24% and its loss in final follow up was 2%. There was no significant difference in loss of correction of vertebral kyphosis and vertebral height in short segment and long segment fi xation in final follow up.Conclusion: Long segment posterior instrumentation results in good reduction and its maintenance for Arbeitsgemeinschaft fur Osteosynthesefragen type C thoracolumbar fractures whereas similar results can be achieved with short segment posterior instrumentation in type A and type B fractures. Journal of Kathmandu Medical College,Vol. 6, No. 4, Issue 22, Oct.-Dec., 2017, Page: 150-155  

scholarly journals Effect of microscopically assisted decompression with micro-hook scalpel in the surgical treatment of ossification of the posterior longitudinal ligament

2019 ◽  
Vol 47 (10) ◽  
pp. 5120-5129 ◽  
Author(s):  
Sheng Yang ◽  
Jianmin Lu ◽  
Dapeng Fu ◽  
Depeng Shang ◽  
Fei Zhou ◽  
...  
Keyword(s):  
Recovery Rate ◽  
Spinal Canal ◽  
Japanese Orthopaedic Association ◽  
Posterior Longitudinal Ligament ◽  
Clinical Effects ◽  
Posterior Surgery ◽  
Vas Score ◽  
Group A ◽  
Group B

Objective This study was performed to investigate the effect of microscopically assisted decompression using a micro-hook scalpel on ossification of the posterior longitudinal ligament (OPLL). Methods Sixty-one patients with OPLL were divided into Group A (posterior surgery with laminectomy of the responsible segment and lateral mass screw fixation) and Group B (anterior cervical corpectomy with intervertebral titanium cage fusion). Neurological function was assessed by the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and recovery rate. The fixation status and the result of spinal canal decompression were radiographically assessed. Results In Groups A and B, the JOA score was significantly higher and the VAS score was significantly lower at 1 week postoperatively and at the final follow-up than during the preoperative period. The mean recovery rate in Group A and B was 59.92% ± 13.46% and 62.28% ± 14.00%, respectively. Postoperative radiographs showed good positioning and no damage to the internal fixation materials. The spinal canal was also fully decompressed. Conclusions Microscopically assisted decompression with a micro-hook scalpel in both anterior and posterior surgeries achieved good clinical effects in patients with OPLL.

Anterior instrumentation surgery for the treatment of Lenke type 1AR curve patterns

2021 ◽  
pp. 1-8
Author(s):  
Satoshi Inami ◽  
Hiroshi Moridaira ◽  
Daisaku Takeuchi ◽  
Tsuyoshi Sorimachi ◽  
Haruki Ueda ◽  
...  
Keyword(s):  
Progressive Increase ◽  
Surgical Results ◽  
Disc Space ◽  
Anterior Surgery ◽  
Posterior Surgery ◽  
Posterior Group ◽  
The Right ◽  
Curve Patterns ◽  
Anterior Group

OBJECTIVE Previous studies have demonstrated that Lenke lumbar modifier A contains 2 distinct types (AR and AL), and the AR curve pattern is likely to develop adding-on (i.e., a progressive increase in the number of vertebrae included within the primary curve distally after posterior surgery). However, the results of anterior surgery are unknown. The purpose of this study was to present the surgical results in a cohort of patients undergoing scoliosis treatment for type 1AR curves and to compare anterior and posterior surgeries to consider the ideal indications and advantages of anterior surgery for type 1AR curves. METHODS Patients with a Lenke type 1 or 2 and lumbar modifier AR (L4 vertebral tilt to the right) and a minimum 2-year postoperative follow-up were included. The incidence of adding-on and radiographic data were compared between the anterior and posterior surgery groups. The numbers of levels between the end, stable, neutral, and last touching vertebra to the lower instrumented vertebra (LIV) were also evaluated. RESULTS Forty-four patients with a mean follow-up of 57 months were included. There were 14 patients in the anterior group and 30 patients in the posterior group. The main thoracic Cobb angle was not significantly different between the groups preoperatively and at final follow-up. At final follow-up, the anterior group had significantly less tilting of the LIV than the posterior group (−0.8° ± 4.5° vs 3° ± 4°). Distal adding-on was observed in no patient in the anterior group and in 6 patients in the posterior group at final follow-up (p = 0.025). In the anterior group, no LIV was set below the end vertebra, and all LIVs were set above last touching vertebra. The LIV was significantly more proximal in the anterior group than in the posterior surgery patients without adding-on for all reference vertebrae (p < 0.001). CONCLUSIONS This is the first study to investigate the surgical results of anterior surgery for Lenke type 1AR curve patterns, and it showed that anterior surgery for the curves could minimize the distal extent of the instrumented fusion without adding-on. This would leave more mobile disc space below the fusion.

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