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Li J, Zhang J, Xian S, Bai W, Liu Y, Sun Z, Wang Y, Yu M, Li W, Zeng Y, Tian Y. Modified pedicle subtraction osteotomy for osteoporotic vertebral compression fractures: a retrospective study of 104 patients. 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; 33:3275-3283. [PMID: 38858266 DOI: 10.1007/s00586-024-08335-1] [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: 09/04/2023] [Revised: 03/01/2024] [Accepted: 05/23/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Osteoporotic vertebral compression fractures (OVCF) caused by osteoporosis is a common clinical fracture type. There are many surgical treatment options for OVCF, but there is a lack of comparison among different options. Therefore, we counted a total of 104 cases of OVCF operations with different surgical plans, followed up the patients, and compared the surgical outcome indications before, after and during the follow-up. METHOD 104 patients who underwent posterior osteotomy (Modified PSO, SPO, PSO, VCR) and kyphosis correction surgery at our hospital between April 2006 and August 2021 with a minimum follow-up period of 24 months were included. All cases were injuries induced by a fall incurred while standing or lifting heavy objects without high-energy trauma. The mean CT value was 71 HU, which was below 110 HU, indicating severe osteoporosis. The indications for surgery included gait disturbance due to severe pain with pseudarthrosis, increased kyphotic angle, and progressive neurological symptoms. Pre- and postoperative CL, TLK, TK, PrTK, TKmax, GK, LL, PI, SS, PT, SVA, TPA, were investigated radiologically. Additionally, We evaluated estimated blood loss, surgical time and perioperative symptom. RESULT The results show, after operation, TLK (37.32 ± 10.61° vs. 11.01 ± 8.06°, P < 0.001), TK (35.42 ± 17.64° vs. 25.62 ± 12.24°, P < 0.001), TKmax (49.71 ± 16.32° vs. 24.12 ± 13.34°, P < 0.001), SVA (44.91 ± 48.67 vs. 23.52 ± 30.21, P = 0.013), CL (20.23 ± 13.21° vs. 11.45 ± 9.85°, P = 0.024) and TPA (27.44 ± 12.76° vs. 13.91 ± 9.24°, P = 0.009) were improved significantly in modified Pedicle subtraction osteotomy (mPSO) after operation. During follow-up, TLK (37.32 ± 10.61° vs. 13.88 ± 10.02°, P < 0.001) and TKmax (49.71 ± 16.32° vs. 24.12 ± 13.34°, P < 0.001) were improved significantly in Modified PSO group. In additon, estimated blood loss (790.0 ± 552.2 ml vs. 987.0 ± 638.5 ml, P = 0.038), time of operation (244.1 ± 63.0 min vs. 292.4 ± 87.6 min, P = 0.025) were favorable in Modified PSO group compared to control group. CONCLUSION To conclude, mPSO could acquire a favorable degree of kyphosis correction as well as fewer follow-up complications. Compared with other surgical methods, it also has the advantages of less surgical trauma and shorter operation time. It can be an effective solution for the treatment of OVCF.
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Affiliation(s)
- Junyu Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Jiahao Zhang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Siming Xian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Wenbin Bai
- Peking University Health Science Center, Beijing, China
| | - Yihao Liu
- Peking University Health Science Center, Beijing, China
| | - Zhuoran Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Yongqiang Wang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Miao Yu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Weishi Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
| | - Yan Zeng
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
| | - Yun Tian
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
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Tanaka M, Al Askar AEK, Kumawat C, Ekade SJ, Uotani K. A New Minimally Invasive Technique for Thoracolumbar/Lumbar Focal Kyphosis Due to Osteoporotic Vertebral Fracture: A Case Report. Cureus 2024; 16:e66069. [PMID: 39229420 PMCID: PMC11368576 DOI: 10.7759/cureus.66069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2024] [Indexed: 09/05/2024] Open
Abstract
Osteoporotic vertebral fractures are common fractures in the elderly population and are often associated with low back pain and disruption in daily living activities. Reconstruction surgeries, such as corpectomy, are among the treatment options for these conditions. However, a corpectomy requires a longer surgical procedure and involves a significant amount of blood loss. We present the case of an 80-year-old woman with severe low back pain due to an L2 fracture and focal kyphosis treated with a novel minimally invasive technique. The patient underwent anterior and posterior surgery in the right decubitus position using a C-arm-free technique. Hyperlordotic cages were inserted in the upper and lower disc space via a lateral approach, while percutaneous pedicle screws were inserted from a posterior approach. These procedures were performed simultaneously under navigation guidance only.
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Affiliation(s)
- Masato Tanaka
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, JPN
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama, JPN
| | | | - Chetan Kumawat
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, JPN
| | - Shashank J Ekade
- Department of Orthopedic Surgery, Okayama Rosai Hospital, Okayama, JPN
| | - Koji Uotani
- Department of Orthopedic Surgery, Okayama University Hospital, Okayama, JPN
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Gelvez D, Dong K, Redlich N, Williams J, Bhandutia A, Shamassian B. Treatment Strategies in the Osteoporotic Spine. Orthop Clin North Am 2024; 55:403-413. [PMID: 38782511 DOI: 10.1016/j.ocl.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
This article reviews the appropriate assessment and management of osteoporotic compression fractures and discusses the implications of osteoporosis on initial patient evaluation, medical optimization for surgery, selection of instrumentation, and surgical technique. Adverse outcomes associated with osteoporosis are discussed. Failure to appropriately evaluate, optimize, and treat spine patients with osteoporotic bone can lead to disastrous complications. Weakened bone can lead to implant failure through cage subsidence and screw pullout, as well as, peri-implant fractures, failure of deformity correction, and proximal kyphosis. These risks must be taken into account when considering operative interventions in these patients.
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Affiliation(s)
- Daniel Gelvez
- LSU-HSC Department of Orthopaedics, 2021 Perdido Street, 7th Floor, New Orleans, LA 70112, USA.
| | - Katherine Dong
- LSU-HSC Department of Orthopaedics, 2021 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Nathan Redlich
- LSU-HSC Department of Orthopaedics, 2021 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Jestin Williams
- LSU-HSC Department of Orthopaedics, 2021 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Amit Bhandutia
- LSU-HSC Department of Orthopaedics, 2021 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
| | - Berje Shamassian
- LSU-HSC Department of Neurosurgery, 2021 Perdido Street, 7th Floor, New Orleans, LA 70112, USA
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Kapetanakis S, Gkantsinikoudis N, Apostolakis S, Tsioulas P, Chaniotakis C. Posterolateral Instrumented Fusion in Elderly Patients With a Single Osteoporotic Vertebral Fracture: Evaluation of Health-Related Quality of Life. Cureus 2024; 16:e53498. [PMID: 38440031 PMCID: PMC10910638 DOI: 10.7759/cureus.53498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction Treatment of osteoporotic vertebral fractures (OVFs) is a factor that affects the quality of life and should be considered during management. In patients with a single OVF and neurologic deficit, surgical procedures aiming at neural decompression with instrumented fusion should be considered in elderly individuals. Posterolateral instrumented fusion (PLF) constitutes a largely performed fusion surgery for patients featuring indications for fusion surgery. The aim of this study was to determine the safety, effectiveness, and impact on health-related quality of life (HRQoL) of PLF surgery in elderly patients diagnosed with a single OVF. Methods This study was conducted at Interbalkan European Medical Center, Thessaloniki, Greece. Eighty (80) consecutive individuals with OVFs were subjected to PLF and recruited in this prospectively designed non-randomized study. Clinical evaluation was performed preoperatively and postoperatively at particular chronic intervals at one, three, six, and 12 months and two years. The assessment was conducted via the standardized Visual Analogue Scale (VAS) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire for pain and HRQoL, respectively. Results No major perioperative complications were observed. All parameters of SF-36 presented significant improvement over the entire follow-up period with VAS scores reaching a plateau at six months. Depicted improvement of these parameters proves the beneficial role of PLF in elderly patients who suffered from a single OVF with or without referable neurological deficit. Conclusion OVFs have a significant impact on the quality of life of elderly patients, and surgical treatment with PLF with or without decompression can lead to functional recovery, pain relief, and HRQoL amelioration. Our results demonstrated that the outcomes of PLF in the surgical treatment of these patients are remarkably favorable, demonstrating the safety and efficacy of the technique.
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Affiliation(s)
- Stylianos Kapetanakis
- Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, GRC
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, GRC
| | | | - Sotirios Apostolakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, GRC
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Di Martino A, Villari E, Poluzzi R, Brunello M, Rossomando V, D’Agostino C, Ruta F, Faldini C. Role of biophysical stimulation in multimodal management of vertebral compression fractures. Comput Struct Biotechnol J 2023; 21:5650-5661. [PMID: 38047233 PMCID: PMC10692617 DOI: 10.1016/j.csbj.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 12/05/2023] Open
Abstract
Raised life expectancy and aging of the general population are associated with an increased concern for fragility fractures due to factors such as osteoporosis, reduced bone density, and an higher risk of falls. Among these, the most frequent are vertebral compression fractures (VCF), which can be clinically occult. Once the diagnosis is made, generally thorough antero-posterior and lateral views of the affected spine at the radiographs, a comprehensive workup to assess the presence of a metabolic bone disease or secondary causes of osteoporosis and bone frailty is required. Treatment uses a multimodal management consisting of a combination of brace, pain management, bone metabolism evaluation, osteoporosis medication and has recently incorporated biophysical stimulation, a noninvasive technique that uses induced electric stimulation to improve bone recovery through the direct and indirect upregulation of bone morphogenic proteins, stimulating bone formation and remodeling. It contributes to the effectiveness of the therapy, promoting accelerated healing, supporting the reduction of bed rest and pain medications, improving patients' quality of life, and reducing the risk to undergo surgery in patients affected by VCFs. Therefore, the aim of this review is to outline the fundamental concepts of multimodal treatment for VCF, as well as the present function and significance of biophysical stimulation in the treatment of VCF patients.
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Affiliation(s)
- Alberto Di Martino
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Eleonora Villari
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Riccardo Poluzzi
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Matteo Brunello
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Valentino Rossomando
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Claudio D’Agostino
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Federico Ruta
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatologic Department, IRCCS Istituto Ortopedico Rizzoli, Via G.B. Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Long Z, Gong F, Xiong L, Wen J, Chen G. Modified posterior osteotomy for osteoporotic vertebral collapse with neurological dysfunction in thoracolumbar spine: a preliminary study. J Orthop Surg Res 2023; 18:688. [PMID: 37715231 PMCID: PMC10502986 DOI: 10.1186/s13018-023-04189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE The risk of osteoporotic vertebral collapse (OVC) associated with delayed neurological dysfunction (DND) is substantial, and performing surgery for this condition in elderly patients presents challenges. The focus of the current research is on simplifying surgical procedures while maintaining their effectiveness. This study was designed to contribute clinical data supporting the use of modified posterior osteotomy for treating thoracolumbar OVC with DND. The study compares perioperative clinical parameters, imaging data characteristics, and changes in efficacy outcome indicators to provide evidence for the advancement of this technique. METHODS A total of 12 patients diagnosed with osteoporotic vertebral collapse and neurological dysfunction were included in the study. All patients underwent modified posterior osteotomy. Data regarding perioperative and radiological parameters as well as complications such as surgery duration, blood loss, ASIA grade, VAS, ODI, regional kyphosis angle (RKA), anterior vertebral height ratio (AVHr), and spinal canal clearance ratio (SCCr), were collected retrospectively. These parameters were then analysed to evaluate the clinical efficacy and safety of the modified posterior osteotomy technique. RESULTS A total of 12 patients were included in the study, with a mean age of 65.5 ± 9.7 years. The average follow-up period was 29.4 ± 5.0 months. The mean operative blood loss was 483.3 ± 142.0 ml, and the average operative time was 3.7 ± 0.7 h. The visual analogue scale (VAS) score decreased from a preoperative value of 5.8 ± 0.7 to a final follow-up value of 1.3 ± 0.8 (P < 0.05), indicating a significant improvement in pain. The ODI decreased from 65.2 ± 6.0 before surgery to 20.5 ± 7.0, indicating a decrease in disability, and the postoperative neurological function showed a significant improvement. Correction of the RKA was observed, with the angle changing from 35.8 ± 10.8° before surgery to 20.0 ± 3.5° after surgery and to 22.5 ± 3.1° at the final follow-up. Similarly, correction of the AVHr was observed, with the height changing from 39.3 ± 18.0 to 63.0 ± 14.3 after surgery and to 53.9 ± 8.9 at the final follow-up. Correction of the SCCr was also observed, with the ratio changing from 54.9 ± 5.4 to 68.1 ± 5.3 after surgery and to 68.68 ± 6.76 at the final follow-up. CONCLUSIONS Posterior modified osteotomy is an effective treatment for thoracolumbar osteoporotic fractures with OVC combined with DND. It can significantly preserve vertebral height, increase vertebral canal volume, correct kyphotic angle, and improve postoperative neurological function. The simplified osteotomy also offers advantages in terms of operating time, blood loss, postoperative VAS score, and improvement in lumbar function.
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Affiliation(s)
- Zhisheng Long
- Medical College, Nanchang University, Nanchang, 330006, Jiangxi, China
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Feipeng Gong
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
| | - Long Xiong
- Department of Orthopedics, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi, China
| | - Jiabin Wen
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China.
| | - Gang Chen
- Department of Orthopedics, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, Jiangxi, China
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Ortona E, Pagano MT, Capossela L, Malorni W. The Role of Sex Differences in Bone Health and Healing. BIOLOGY 2023; 12:993. [PMID: 37508423 PMCID: PMC10376157 DOI: 10.3390/biology12070993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/09/2023] [Indexed: 07/30/2023]
Abstract
Fracture healing is a long-term and complex process influenced by a huge variety of factors. Among these, there is a sex/gender disparity. Based on significant differences observed in the outcome of bone healing in males and females, in the present review, we report the main findings, hypotheses and pitfalls that could lead to these differences. In particular, the role of sex hormones and inflammation has been reported to have a role in the observed less efficient bone healing in females in comparison with that observed in males. In addition, estrogen-induced cellular processes such as autophagic cell cycle impairment and molecular signals suppressing cell cycle progression seem also to play a role in female fracture healing delay. In conclusion, it seems conceivable that a complex framework of events could contribute to the female bias in bone healing, and we suggest that a reappraisal of the compelling factors could contribute to the mitigation of sex/gender disparity and improve bone healing outcomes.
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Affiliation(s)
- Elena Ortona
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Maria Teresa Pagano
- Center for Gender Specific Medicine, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Lavinia Capossela
- Institute of Pediatrics, Fondazione Policlinico A. Gemelli IRCCS-Università Cattolica Sacro Cuore, 00168 Rome, Italy
| | - Walter Malorni
- Center for Global Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Wang K, Zhang W, Zhai Y, Zhang F, Yin W, Sun L, Hua Z, Cui X, Yu H. Effect of Position on Regional Kyphosis Angle in Patients with Kyphosis Secondary to Symptomatic Old Osteoporotic Thoracolumbar Fracture. World Neurosurg 2023; 171:e731-e737. [PMID: 36581156 DOI: 10.1016/j.wneu.2022.12.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the effect of position on regional kyphosis angle (RKA) in patients with kyphosis secondary to symptomatic old osteoporotic thoracolumbar fracture (so-OTLF). METHODS The authors evaluated the radiographic data of patients with kyphosis secondary to so-OTLF who underwent posterior corrective fusion surgery in our hospital. The spine sagittal parameters were evaluated in the standing position preoperatively. RKA was measured under standing radiograph, full-length spine computed tomography image in prone position and intraoperative prone X-ray radiograph, respectively. Changes in RKA were compared between groups. RESULTS Thirty-three patients were included. The average RKAs in the standing position, preoperative prone position, and intraoperative prone position were 46.2°, 31.1°, and 30.5° respectively. RKA decreased significantly from standing to preoperative prone position or intraoperative prone position (P < 0.001). In 93.9% (31/33) of the patients, the difference between preoperative prone RKA and intraoperative prone RKA was within 5°. The changes in RKA from standing to intraoperative prone position in the moderate to severe kyphosis group were significantly greater than those in the mild kyphosis group (P < 0.001). CONCLUSIONS The reductive effect of the intraoperative prone position was greater in patients with moderate to severe kyphosis deformities. RKA in the preoperative prone position was almost the same as the RKA in the intraoperative prone position. Therefore, assessing preoperative full-length spine computed tomography in the prone position helped formulate the plan for corrective surgery in patients with kyphosis secondary to so-OTLF.
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Affiliation(s)
- Kangkang Wang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Wei Zhang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Yunlei Zhai
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Feng Zhang
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Wen Yin
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Lele Sun
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China
| | - Zikai Hua
- School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China
| | - Xilong Cui
- School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China
| | - Haiyang Yu
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, Fuyang, Anhui, China; Spinal Deformity Clinical Medicine and Research Center of Anhui Province, Fuyang, Anhui, China; School of Mechatronics Engineering and Automation, Shanghai University, Shanghai, China.
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9
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Wang K, Zhang F, Zhai Y, Zhang W, Yin W, Sun L, Cui X, Yu H. Can preoperative magnetic resonance imaging be used for sagittal kyphotic flexibility assessment in patients with kyphosis secondary to symptomatic old osteoporotic thoracolumbar fracture? J Orthop Surg Res 2023; 18:133. [PMID: 36823630 PMCID: PMC9948522 DOI: 10.1186/s13018-023-03624-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE This study aimed to investigate whether preoperative magnetic resonance imaging (MRI) can be used for sagittal kyphotic (SK) flexibility assessment in patients with kyphosis secondary to symptomatic old osteoporotic thoracolumbar fracture (so-OTLF). METHODS The authors evaluated the radiographic data of patients with kyphosis secondary to so-OTLF. All patients underwent posterior corrective fusion surgery in the hospital. Spinal sagittal parameters were measured on standing radiographs preoperatively. The regional kyphosis angle (RKA) was also measured on preoperative supine MRI and intraoperative prone radiographs on the surgical frame. The SK flexibility in patients with kyphosis secondary to so-OTLF was defined as the difference from the RKA measured on the standing radiographs to that measured on the intraoperative prone radiographs or preoperative supine MRI. The difference and the correlation between the SK flexibility measured by these two methods were compared and analyzed. RESULTS Thirty-seven patients were included. The RKA measured on standing radiographs, supine MRI, and intraoperative prone radiographs were 48.0°, 34.4°, and 32.0°, respectively. Compared with the RKA measured in standing position, the RKA measured on supine MRI decreased by 13.6° (95% confidence interval 11.4°-15.8°), whereas that measured on intraoperative prone radiographs decreased by 16.1° (95% confidence interval 13.7°-18.5°). A linear correlation existed between the SK flexibility measured on supine MRI and that measured on intraoperative prone radiographs, with a mean difference of 2.4° (R2 = 0.912, p < 0.001). CONCLUSION The degree of regional kyphosis deformity was reduced by self-reduction of the intraoperative surgical frame. With a predictive value similar to an intraoperative prone radiograph, preoperative supine MRI can be used for SK flexibility assessment in patients with kyphosis secondary to so-OTLF. The ability to predict the intraoperative degree of regional kyphosis deformity with positioning before an operation may help with surgical planning and patient counseling regarding expectations and risks of surgery.
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Affiliation(s)
- Kangkang Wang
- grid.186775.a0000 0000 9490 772XDepartment of Orthopedics, Affiliated Fuyang People’s Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000 Anhui China ,Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000 Anhui China
| | - Feng Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Orthopedics, Affiliated Fuyang People’s Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000 Anhui China ,Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000 Anhui China
| | - Yunlei Zhai
- grid.186775.a0000 0000 9490 772XDepartment of Orthopedics, Affiliated Fuyang People’s Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000 Anhui China ,Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000 Anhui China
| | - Wei Zhang
- grid.186775.a0000 0000 9490 772XDepartment of Orthopedics, Affiliated Fuyang People’s Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000 Anhui China ,Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000 Anhui China
| | - Wen Yin
- grid.186775.a0000 0000 9490 772XDepartment of Orthopedics, Affiliated Fuyang People’s Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000 Anhui China ,Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000 Anhui China
| | - Lele Sun
- grid.186775.a0000 0000 9490 772XDepartment of Orthopedics, Affiliated Fuyang People’s Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000 Anhui China ,Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000 Anhui China
| | - Xilong Cui
- School of Mechatronics Engineering and Automation, Shanghai University, 333 Nanchen Road, Shanghai, 200072, China.
| | - Haiyang Yu
- Department of Orthopedics, Affiliated Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China. .,Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China. .,School of Mechatronics Engineering and Automation, Shanghai University, 333 Nanchen Road, Shanghai, 200072, China.
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10
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Gao H, Huang J, Wei Q, He C. Advances in Animal Models for Studying Bone Fracture Healing. Bioengineering (Basel) 2023; 10:bioengineering10020201. [PMID: 36829695 PMCID: PMC9952559 DOI: 10.3390/bioengineering10020201] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Fracture is a common traumatic injury that is mostly caused by traffic accidents, falls, and falls from height. Fracture healing is a long-term and complex process, and the mode of repair and rate of healing are influenced by a variety of factors. The prevention, treatment, and rehabilitation of fractures are issues that urgently need to be addressed. The preparation of the right animal model can accurately simulate the occurrence of fractures, identify and observe normal and abnormal healing processes, study disease mechanisms, and optimize and develop specific treatment methods. We summarize the current status of fracture healing research, the characteristics of different animal models and the modeling methods for different fracture types, analyze their advantages and disadvantages, and provide a reference basis for basic experimental fracture modeling.
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Affiliation(s)
- Hui Gao
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Jinming Huang
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Quan Wei
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu 610041, China
- Correspondence: (Q.W.); (C.H.)
| | - Chengqi He
- Rehabilitation Medicine Center and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu 610041, China
- Correspondence: (Q.W.); (C.H.)
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11
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Wen Z, Mo X, Ma H, Li H, Liao C, Fu D, Cheung WH, Qi Z, Zhao S, Chen B. Study on the Optimal Surgical Scheme for Very Severe Osteoporotic Vertebral Compression Fractures. Orthop Surg 2022; 15:448-459. [PMID: 36444956 PMCID: PMC9891906 DOI: 10.1111/os.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Therapy of very severe osteoporotic compression fractures (VSOVCF) has been a growing challenge for spine surgeons. Opinions vary regarding the optimal surgical procedure for the treatment of VSOVCF and which internal fixation method is more effective is still under debate, and research on this topic is lacking. This retrospective study was conducted to compare the efficacy and safety of various pedicle screw fixation methods for treating VSOVCF. METHODS This single-center retrospective comparative study was conducted between January 2015 and September 2020. Two hundred and one patients were divided into six groups according to different surgical methods: 45 patients underwent long-segment fixation (Group 1); 39 underwent short-segment fixation (Group 2); 30 received long-segment fixation with cement-reinforced screws (Group 3); 32 received short-segment fixation with cement-reinforced screws (Group 4); 29 had long-segment fixation combined with kyphoplasty (PKP) (Group 5); and 26 cases had short-segment fixation combined with PKP (Group 6). The clinical records were reviewed and the visual analogue scale (VAS) score and the Oswestry Disability Index (ODI) score were used for clinical evaluation. The vertebral height (VH), fractured vertebral body height (FVBH), and Cobb's angle were objectively calculated and analyzed on lateral plain radiographs. Student's t-tests and one-way ANOVA among groups were conducted to analyze the continuous, and the chi-squared test was used to compare the dichotomous or categorical variables. The difference was considered statistically significant when the P-value was less than 0.05. RESULTS The six groups had similar distributions in age, gender, course of the disease, follow-up period, and injured level. In the postoperative assessment of the VAS score, the surgical intervention most likely to rank first in terms of pain relief was the short-segment fixation with cement-reinforced screws (Group 4). For the functional evaluation, the surgical intervention that is most likely to rank first in terms of ODI score was a short-segment fixation with cement-reinforced screws (Group 4), followed by long-segment fixation (Group 1). The long-segment fixation with cement-reinforced screws was the first-ranked surgical intervention for the maintenance of Cobb's angle and vertebral height, whereas the short-segment fixation performed the worst. The highest overall complication rate was in Group 6 with an incidence of 42.3% (11/26), followed by Group 2 with an incidence of 38.5% (15/39). CONCLUSION For the treatment of VSOVCF, the short-segment fixation with cement-reinforced screws is the most effective and optimal procedure, and should be used as the preferred surgical method if surgeons are proficient in using cemented screws; otherwise, directly and unquestionably use long-segment fixation to achieve satisfactory clinical results.
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Affiliation(s)
- Zhenxing Wen
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Xiaoyi Mo
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Hangzhan Ma
- Department of Orthopedics, Panyu Hospital of Chinese MedicineGuangzhou University of Chinese MedicineGuangzhouChina
| | - Haonan Li
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Changhe Liao
- Department of Orthopedics, Panyu Hospital of Chinese MedicineGuangzhou University of Chinese MedicineGuangzhouChina
| | - Dan Fu
- Department of OrthopaedicsKiang Wu HospitalMacauChina
| | - Wing Hoi Cheung
- Department of Orthopaedics and Traumatology, Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina
| | - Zhichao Qi
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Department of OrthopaedicsThe Seventh Affiliated Hospital of Sun Yat‐sen UniversityShenzhenChina
| | - Shengli Zhao
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Bailing Chen
- Department of Spine Surgery, The First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina,Guangdong Provincial Key Laboratory of Orthopedics and TraumatologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
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12
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Segi N, Nakashima H, Kanemura T, Satake K, Ito K, Tsushima M, Tanaka S, Ando K, Machino M, Ito S, Yamaguchi H, Koshimizu H, Tomita H, Ouchida J, Morita Y, Imagama S. Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture. J Clin Med 2021; 10:5664. [PMID: 34884365 PMCID: PMC8658075 DOI: 10.3390/jcm10235664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the current study was to compare outcomes between lateral access vertebral reconstruction (LAVR) using a rectangular footplate cage and the conventional procedure using a cylindrical footplate cage in patients with osteoporotic vertebral fracture (OVF). We included 46 patients who underwent anterior-posterior combined surgery for OVF: 24 patients underwent LAVR (Group L) and 22 underwent the conventional procedure (Group C). Preoperative, postoperative, and 1- and 2-year follow-up X-ray images were used to measure local lordotic angle, correction loss, and cage subsidence (>2 mm in vertebral endplate depression). In anterior surgery, the operation time was significantly shorter (183 vs. 248 min, p < 0.001) and the blood loss was significantly less (148 vs. 406 mL, p = 0.01) in Group L than in Group C. In Group C, two patients had anterior instrumentation failure. Correction loss was significantly smaller in Group L than in Group C (1.9° vs. 4.9° at 1 year, p = 0.02; 2.5° vs. 6.5° at 2 years, p = 0.04, respectively). Cage subsidence was significantly less in Group L than in Group C (29% vs. 80%, p < 0.001). LAVR using a rectangular footplate cage is an effective treatment for OVF to minimize surgical invasiveness and postoperative correction loss.
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Affiliation(s)
- Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Kotaro Satake
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Kenyu Ito
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Hidetoshi Yamaguchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Hiroyuki Tomita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Jun Ouchida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Yoshinori Morita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
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Alhashash M, Shousha M. Minimally Invasive Short-Segment Anteroposterior Surgery for Thoracolumbar Osteoporotic Fractures with Canal Compromise: A Prospective Study with a Minimum 2-Year Follow-up. Asian Spine J 2021; 16:28-37. [PMID: 33957023 PMCID: PMC8874002 DOI: 10.31616/asj.2020.0573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022] Open
Abstract
Study Design A prospective study with a minimum follow-up of 24 months. Purpose This study aimed to evaluate the results of minimally invasive anteroposterior surgery for osteoporotic vertebral fractures (OVFs) associated with bony spinal canal compromise in elderly patients. Overview of Literature There is a recent increase in the incidence of osteoporosis with OVFs, causing an increasing burden on medical systems. Methods The study included 47 patients, of whom 45 completed a minimum of 24-month follow-up. The inclusion criteria were OVF types 3 and 4 according to the osteoporotic fracture classification in patients aged ≥65 years with bony stenosis. The surgical management consisted of anterior corpectomy and decompression using a thoracoscopic or mini-laparotomy approach, together with posterior percutaneous cement-augmented short-segment fixation. Self-reported outcome measures included Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) in the preoperative phase and regular follow-up at a minimum of 24 months. Radiological measures included segmental lordosis, dual-energy X-ray absorptiometry for osteoporosis assessment, and radiological fracture healing. Results There were 33 patients with lumbar fracture and 12 patients with thoracic fracture. Thirteen patients had preoperative neurological deficits. The mean age was 77.4±8.3 years. The mean preoperative VAS score was 8.12±1.5, and the mean ODI score was 24.4±8.2. The mean preoperative sagittal Cobb angle was 6.3°±4.2° kyphosis. The mean operative time was 220.3±55.5 minutes, with a mean blood loss of 360.75±200.6 mL. After a mean follow-up of 32.6±6.4 months, the mean VAS significantly improved to 2.3, and the ODI to 12. Only three patients still had a partial neurological deficit. The mean final sagittal Cobb angle was significantly better, with 12.5°±4.3° of lordosis. Conclusions Short-segment percutaneous fixation with cement augmentation combined with minimally invasive anterior decompression and corpectomy is a less invasive and safe approach in elderly patients with OVF and canal compromise.
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Affiliation(s)
- Mohamed Alhashash
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.,Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt
| | - Mootaz Shousha
- Department of Spine Surgery, Zentralklinik Bad Berka, Bad Berka, Germany.,Department of Orthopedic Surgery, Alexandria University, Alexandria, Egypt
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14
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Sollmann N, Löffler MT, Kronthaler S, Böhm C, Dieckmeyer M, Ruschke S, Kirschke JS, Carballido-Gamio J, Karampinos DC, Krug R, Baum T. MRI-Based Quantitative Osteoporosis Imaging at the Spine and Femur. J Magn Reson Imaging 2020; 54:12-35. [PMID: 32584496 DOI: 10.1002/jmri.27260] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/31/2020] [Accepted: 06/01/2020] [Indexed: 12/27/2022] Open
Abstract
Osteoporosis is a systemic skeletal disease with a high prevalence worldwide, characterized by low bone mass and microarchitectural deterioration, predisposing an individual to fragility fractures. Dual-energy X-ray absorptiometry (DXA) has been the clinical reference standard for diagnosing osteoporosis and for assessing fracture risk for decades. However, other imaging modalities are of increasing importance to investigate the etiology, treatment, and fracture risk. The purpose of this work is to review the available literature on quantitative magnetic resonance imaging (MRI) methods and related findings in osteoporosis at the spine and proximal femur as the clinically most important fracture sites. Trabecular bone microstructure analysis at the proximal femur based on high-resolution MRI allows for a better prediction of osteoporotic fracture risk than DXA-based bone mineral density (BMD) alone. In the 1990s, T2 * mapping was shown to correlate with the density and orientation of the trabecular bone. Recently, quantitative susceptibility mapping (QSM), which overcomes some of the limitations of T2 * mapping, has been applied for trabecular bone quantifications at the spine, whereas ultrashort echo time (UTE) imaging provides valuable surrogate markers of cortical bone quantity and quality. Magnetic resonance spectroscopy (MRS) and chemical shift encoding-based water-fat MRI (CSE-MRI) enable the quantitative assessment of the nonmineralized bone compartment through extraction of the bone marrow fat fraction (BMFF). Furthermore, CSE-MRI allows for the differentiation of osteoporotic vs. pathologic fractures, which is of high clinical relevance. Lastly, advanced postprocessing and image analysis tools, particularly considering statistical parametric mapping and region-specific BMFF distributions, have high potential to further improve MRI-based fracture risk assessments at the spine and hip. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 2.
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Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Maximilian T Löffler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Sophia Kronthaler
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christof Böhm
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Michael Dieckmeyer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stefan Ruschke
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Julio Carballido-Gamio
- Department of Radiology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Dimitrios C Karampinos
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Roland Krug
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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15
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Sato K, Yamada Y, Kogawa M, Sekiguchi T. Vertebral mobility is a valuable indicator for predicting and determining bone union in osteoporotic vertebral fractures: a conventional observation study. J Orthop Surg Res 2020; 15:166. [PMID: 32370793 PMCID: PMC7201770 DOI: 10.1186/s13018-020-01649-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/27/2020] [Indexed: 12/30/2022] Open
Abstract
Background Conservative treatments for osteoporotic vertebral fractures (OVFs) have not been standardized, and criteria for determining bone union have not been established. To determine bone union, we have adopted a cutoff value of 1.0 mm for vertebral mobility (V-mobility), defined as the difference in anterior vertebral height (Ha) between lateral radiographs taken in weight-bearing and non-weight-bearing positions. The present study aimed to investigate the usefulness of V-mobility for determining bone union and predicting bone union at 6 months after OVF onset. Methods The study included 54 acute OVFs from T11 to L3 in 53 patients (12 males, 41 females; mean age 82 years; age range 55–97 years) who were hospitalized at ≤ 3 weeks after OVF onset. Vertebral deformity (V-deformity) and V-mobility were evaluated in accordance with Ha on lateral radiographs taken in the sitting position (SIT), lateral decubitus position (DEC), and supine position (SUP). OVFs showing V-mobility of ≤ 1.0 mm between SIT and DEC radiographs and no intravertebral cleft on DEC radiograph were defined as semi-union, while those showing V-mobility of ≤ 1.0 mm between SIT and SUP radiographs and no intravertebral cleft on SUP radiograph were defined as bone union. We calculated the bone union rates including semi-unions associated with V-mobility cutoff values of 1.0 mm, 1.5 mm, and 2.0 mm and estimated cutoff values for V-mobility at 5 weeks after OVF onset to predict bone union at 6 months after OVF onset. Results The cumulative number of bone unions including semi-unions was more influenced by the different V-mobility cutoff values in Ha for determining bone union in the earlier period compared with the later period in the time course of OVF. Receiver-operating characteristic curve analyses revealed that V-mobility cutoff value of 2.1 mm in Ha between SIT and DEC radiographs at 5 weeks after OVF had moderate accuracy for predicting bone union including semi-union at 6 months after OVF. The mean V-deformity value on SIT radiographs did not progress significantly. Conclusion V-mobility in the early stage after OVF can predict bone union at 6 months after OVF and is a useful quantitative indicator for determining bone union.
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Affiliation(s)
- Kozo Sato
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi ku, Sendai, Miyagi, 981-3217, Japan
| | - Yuichiro Yamada
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi ku, Sendai, Miyagi, 981-3217, Japan
| | - Masakazu Kogawa
- Department of Orthopaedic Surgery, Matsuda Hospital, 17-1 Sanezawa aza Tatsutayashiki, Izumi ku, Sendai, Miyagi, 981-3217, Japan. .,Centre for Orthopaedics and Trauma Research, Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Takuya Sekiguchi
- Department of Orthopaedic Science, Iwate Prefectural Central Hospital, 1-4-1, Ueda, Morioka, Iwate, 020-0066, Japan
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