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Zhang Y, Ge J, Liu H, Niu J, Wang S, Shen H, Li H, Qian C, Song Z, Zhu P, Zhu X, Zou J, Yang H. Kyphoplasty is associated with reduced mortality risk for osteoporotic vertebral compression fractures: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1490-1497. [PMID: 38062266 DOI: 10.1007/s00586-023-08032-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/15/2023] [Accepted: 10/25/2023] [Indexed: 04/06/2024]
Abstract
BACKGROUND Vertebral augmentation, such as vertebroplasty (VP) or kyphoplasty (KP), has been utilized for decades to treat OVCFs; however, the precise impact of this procedure on reducing mortality risk remains a topic of controversy. This study aimed to explore the potential protective effects of vertebral augmentation on mortality in patients with osteoporotic vertebral compression fractures (OVCFs) using a large-scale meta-analysis. MATERIALS AND METHODS Cochrane Library, Embase, MEDLINE, PubMed and Web of Science databases were employed for literature exploration until May 2023. The hazard ratios (HRs) and 95% confidence intervals (CIs) were utilized as a summary statistic via random-effect models. Statistical analysis was executed using Review Manager 5.3 software. RESULTS After rigorous screening, a total of five studies with substantial sample sizes were included in the quantitative meta-analysis. The total number of participants included in the study was an 2,421,178, comprising of 42,934 cases of vertebral augmentation and 1,991,244 instances of non-operative management. The surgical intervention was found to be significantly associated with an 18% reduction in the risk of mortality (HR 0.82; 95% CI 0.78, 0.85). Subgroup analysis revealed a remarkable 71% reduction in mortality risk following surgical intervention during short-term follow-up (HR 0.29; 95% CI 0.26, 0.32). Furthermore, KP exhibited a superior and more credible decrease in the risk of mortality when compared to VP treatment. CONCLUSIONS Based on a comprehensive analysis of large samples, vertebral augmentation has been shown to significantly reduce the mortality risk associated with OVCFs, particularly in the early stages following fractures. Furthermore, it has been demonstrated that KP is more reliable and effective than VP in terms of mitigating mortality risk.
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Affiliation(s)
- Yijian Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Jun Ge
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Junjie Niu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Shenghao Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Hao Shen
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Hanwen Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Chen Qian
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Zhuorun Song
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Pengfei Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China
| | - Xuesong Zhu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China.
| | - Jun Zou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China.
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, No. 899 Pinghai Road, Suzhou, 215006, Jiangsu, China.
- Orthopaedic Institute, Medical College, Soochow University, Suzhou, 215007, China.
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Hou J, Ren D, Chen Y, Geng L, Yao S, Wu H, Wang P. Effectiveness of the Endplate Reduction Technique Combined With Bone Grafting for the Treatment of Thoracolumbar Fractures by Using Posterior Short-Segment Fixation. Neurospine 2023; 20:353-364. [PMID: 37016884 PMCID: PMC10080432 DOI: 10.14245/ns.2244980.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/09/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: This study aimed to examine the effect of the endplate reduction (EPR) technique combined with bone grafting for treating thoracolumbar burst fractures using posterior short-segmental fixation.Methods: Patients with thoracolumbar fractures admitted between January 2018 and October 2021 were retrospectively analyzed, and those meeting the criteria were assigned to the EPR group and the intermediate screws (IS) group. The vertebral wedge angle (VWA), Cobb angle (CA), anterior vertebral body height (AVBH), middle vertebral body height (MVBH), upper endplate line (UEPL), upper intervertebral angle (UIVA), and upper intervertebral disc height (UIDH) indices were examined and compared preoperatively, first day postoperatively, as well as at 12 months postoperatively.Results: The result indicated that the EPR group achieved better MVBH reduction (p < 0.001), UEPL reduction (p < 0.001), vertebral body fracture healing (p = 0.006), as well as implant breakage (p = 0.04) than the IS group; VWA (p < 0.001), CA (p = 0.005), AVBH (p < 0.001), MVBH (p < 0.001), UEPL (p < 0.001), and UIDH (p < 0.001) were lost after reduction less than those in the IS group. There was no significant difference in operative time (p = 0.315) and intraoperative bleeding (p = 0.274) between the 2 groups.Conclusion: The EPR group achieved better results in repositioning and maintaining MVBH and endplate morphology, with less correction loss after the reduction of the VWA, CA, AVBH, and endplate morphology. The EPR group exhibited a better healing pattern after vertebral fracture and disc degeneration was better relieved.
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Affiliation(s)
- Jiguang Hou
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
- Department of Orthopaedics, First Hospital of Qinhuangdao, Qinhuangdao, China
| | - Dong Ren
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Yufeng Chen
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Lindan Geng
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Shuangquan Yao
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Haotian Wu
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
| | - Pengcheng Wang
- Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, China
- Corresponding Author Pengcheng Wang Orthopaedic Trauma Service Center, The Third Hospital of Hebei Medical University, Major Laboratory of Orthopaedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province 050051, China
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Yaman O, Zileli M, Şentürk S, Paksoy K, Sharif S. Kyphosis After Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations. Neurospine 2022; 18:681-692. [PMID: 35000321 PMCID: PMC8752698 DOI: 10.14245/ns.2142340.170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022] Open
Abstract
Thoracolumbar fractures change the biomechanics of the spine. Load distribution causes kyphosis by the time. Treatment of posttraumatic kyphosis is still controversial. We reviewed the literature between 2010 and 2020 using a search with keywords “thoracolumbar fracture and kyphosis.” We removed osteoporotic fractures, ankylosing spondylitis fractures, non-English language papers, case reports, and low-quality case series. Up-to-date information on posttraumatic kyphosis management was reviewed to reach an agreement in a consensus meeting of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The first meeting was conducted in Peshawar in December 2019 with WFNS Spine Committee members’ presence and participation. The second meeting was a virtual meeting via the internet on June 12, 2020. We utilized the Delphi method to administer the questionnaire to preserve a high degree of validity. We summarized 42 papers on posttraumatic kyphosis. Surgical treatment of thoracolumbar kyphosis due to unstable burst fractures can be done via a posterior only approach. Less blood loss and reduced surgery time are the main advantages of posterior surgery. Kyphosis angle for surgical decision and fusion levels are controversial. However, global sagittal balance should be taken into consideration for the segment that has to be included. Adding an intermediate screw at the fractured level strengthens the construct.
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Affiliation(s)
- Onur Yaman
- Memorial Bahcelievler Spine Center, Istanbul, Turkey
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey
| | - Salim Şentürk
- Memorial Bahcelievler Spine Center, Istanbul, Turkey
| | - Kemal Paksoy
- Memorial Bahcelievler Spine Center, Istanbul, Turkey
| | - Salman Sharif
- Liaquat National Hospital, Department of Neurosurgery, Karachi, Pakistan
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Liang C, Liu G, Liang G, Zheng X, Yin D, Xiao D, Zeng S, Cai H, Chang Y. Healing pattern classification for thoracolumbar burst fractures after posterior short-segment fixation. BMC Musculoskelet Disord 2020; 21:373. [PMID: 32532236 PMCID: PMC7291420 DOI: 10.1186/s12891-020-03386-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/01/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Thoracolumbar burst fractures can be treated with posterior short-segment fixation. However, no classification can help to estimate whether the healed vertebral body will have sufficient stability after implant removal. We aimed to develop a Healing Pattern Classification (HPC) to evaluate the stability of the healed vertebra based on cavity size and location. METHODS Fifty-two thoracolumbar burst fracture patients treated with posterior short-segmental fixation without fusion and followed up for an average of 3.2 years were retrospectively studied. The HPC was divided into 4 types: type I - no cavity; type II - a small cavity with or without the violation of one endplate; type III - a large cavity with or without the violation of one endplate; and type IV - a burst cavity with the violation of both endplates or the lateral cortical shell. The intraobserver and interobserver intraclass correlation coefficients (ICCs) of the HPC were assessed. The demographic characteristics and clinical outcomes of the cohort were compared between the stable group (types I and II) and the unstable group (types III and IV). Logistic regression was conducted to evaluate risk factors for unstable healing. RESULTS The intraobserver and interobserver ICCs of the HPC were 0.86 (95% CI = 0.74-0.90) and 0.77 (95% CI = 0.59-0.86), respectively. While the unstable healing group (types III and IV) accounted for 59.6% of the patients, most of these patients were asymptomatic. The preoperative Load Sharing Classification (LSC) comminution score may predict the occurrence of unstable healing (OR = 8.4, 95% CI = 2.4-29.7). CONCLUSIONS A reliable classification for assessing the stability of a healed vertebra was developed. With type I and II healing, the vertebra is considered stable, and the implant can be removed. With type III healing, the vertebra may have healing potential, but the implant should not be removed unless type II healing is achieved. With type IV healing, the vertebra is considered extremely unstable, and instrumentation should be maintained. Assessing the LSC comminution score preoperatively may help to predict unstable healing after surgery.
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Affiliation(s)
- Changxiang Liang
- Spine departement, Orthopedic center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), 510080, No.106, Zhongshan 2nd Road, Guangzhou, Guangdong Province China
| | - Guihua Liu
- Orthopedic department, Huizhou Municipal Central Hospital, Huizhou City, China
| | - Guoyan Liang
- Spine departement, Orthopedic center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), 510080, No.106, Zhongshan 2nd Road, Guangzhou, Guangdong Province China
| | - Xiaoqing Zheng
- Spine departement, Orthopedic center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), 510080, No.106, Zhongshan 2nd Road, Guangzhou, Guangdong Province China
| | - Dong Yin
- Spine departement, Orthopedic center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), 510080, No.106, Zhongshan 2nd Road, Guangzhou, Guangdong Province China
| | - Dan Xiao
- Spine departement, Orthopedic center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), 510080, No.106, Zhongshan 2nd Road, Guangzhou, Guangdong Province China
| | - Shixing Zeng
- Spine departement, Orthopedic center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), 510080, No.106, Zhongshan 2nd Road, Guangzhou, Guangdong Province China
| | - Honghua Cai
- Orthopedic department, Huizhou Municipal Central Hospital, Huizhou City, China
| | - Yunbing Chang
- Spine departement, Orthopedic center, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), 510080, No.106, Zhongshan 2nd Road, Guangzhou, Guangdong Province China
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