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Okada E, Shiono Y, Nishida M, Mima Y, Funao H, Shimizu K, Kato M, Fukuda K, Fujita N, Yagi M, Nagoshi N, Tsuji O, Ishii K, Nakamura M, Matsumoto M, Watanabe K. Spinal fractures in diffuse idiopathic skeletal hyperostosis: Advantages of percutaneous pedicle screw fixation. J Orthop Surg (Hong Kong) 2020; 27:2309499019843407. [PMID: 31079563 DOI: 10.1177/2309499019843407] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To validate the effectiveness of percutaneous pedicle screw (PPS) fixation for spinal fractures associated with diffuse idiopathic skeletal hyperostosis (DISH) by comparing surgical outcomes for PPS fixation and conventional open posterior fixation. Patients with DISH are vulnerable to unstable spinal fractures caused by trivial trauma, and these fractures have high rates of delayed paralysis, postoperative complications, and mortality. METHODS This retrospective study assessed surgical outcomes for 16 patients with DISH (12 men; mean age 76.1 ± 9.4 years) who underwent PPS fixation for spinal fractures (pedicle screw (PS) group), and for a control group of 25 patients with DISH (18 men; mean age 77.9 ± 9.9 years) who underwent conventional open fixation (O group) at our affiliated hospitals from 2007 to 2017. We evaluated the preoperative physical condition (American Society of Anesthesiologists (ASA) classification), neurological status (Frankel grade), and improvement after surgery, fusion length, operating time, estimated blood loss, and perioperative complications. RESULTS Preoperatively, the PS group consisted of one ASA-1 patient, eight ASA-2 patients, six ASA-3 patients, and one ASA-4 patient; by Frankel grade, there were 2 grade B patients, 13 grade C, 4 grade D, and 6 grade E patients. The O group had 2 ASA-1 patients, 13 ASA-2, 9 ASA-3, and 1 ASA-4 patients. Frankel grades in the O group reflected severe neurological deficits, with 3 grade C patients, 2 grade D, and 11 grade E ( p = 0.032) patients. The two groups had similar rates of neurological improvement (33.3% of PS and 40.0% of O patients; p = 0.410) and mean fusion length (PS 5.1 ± 0.8 segments; O 4.9 ± 1.2). The mean operating time and estimated blood loss were 168.1 ± 46.7 min and 133.9 ± 116.5 g, respectively, in the PS group, and 224.6 ± 49.8 min and 499.9 ± 368.5 g in the O group. Three O-group patients died of hypovolemic shock, respiratory failure, and pneumonia, respectively, within a year of surgery. CONCLUSION Conventional open posterior fixation and PPS fixation for DISH-related spinal fractures were similar in fusion length and neurological improvement. However, PPS fixation was less invasive and had lower complication rates.
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Affiliation(s)
- Eijiro Okada
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Yuta Shiono
- 2 Keio Spine Research Group, Tokyo, Japan.,3 Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Mitsuhiro Nishida
- 2 Keio Spine Research Group, Tokyo, Japan.,3 Department of Orthopaedic Surgery, Saiseikai Central Hospital, Tokyo, Japan
| | - Yuichiro Mima
- 2 Keio Spine Research Group, Tokyo, Japan.,4 Department of Orthopaedic Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Haruki Funao
- 2 Keio Spine Research Group, Tokyo, Japan.,5 Department of Orthopaedic Surgery, International University of Health and Welfare, Chiba, Japan
| | - Kentaro Shimizu
- 2 Keio Spine Research Group, Tokyo, Japan.,6 Department of Orthopaedic Surgery, Sano General Hospital, Tochigi, Japan
| | - Masanori Kato
- 2 Keio Spine Research Group, Tokyo, Japan.,7 Department of Orthopaedic Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kentaro Fukuda
- 2 Keio Spine Research Group, Tokyo, Japan.,8 Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Nobuyuki Fujita
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Mitsuru Yagi
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Narihito Nagoshi
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Osahiko Tsuji
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Ken Ishii
- 2 Keio Spine Research Group, Tokyo, Japan.,5 Department of Orthopaedic Surgery, International University of Health and Welfare, Chiba, Japan
| | - Masaya Nakamura
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Morio Matsumoto
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
| | - Kota Watanabe
- 1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.,2 Keio Spine Research Group, Tokyo, Japan
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Chen L, Liu H, Hong Y, Yang Y, Hu L. Minimally Invasive Decompression and Intracorporeal Bone Grafting Combined with Temporary Percutaneous Short-Segment Pedicle Screw Fixation for Treatment of Thoracolumbar Burst Fracture with Neurological Deficits. World Neurosurg 2019; 135:e209-e220. [PMID: 31786380 DOI: 10.1016/j.wneu.2019.11.123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE We evaluated the clinical and radiographic outcomes of patients with thoracolumbar burst fractures and neurological deficits treated with minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment stabilization. METHODS Patients with thoracolumbar burst fractures and neurological deficits underwent minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment stabilization. Instrumentation was removed approximately 1 year after vertebral fracture union. The clinical and radiographic outcomes were analyzed. RESULTS The mean operative duration and intraoperative bleeding volume were 135 ± 63 minutes and 120 ± 200 mL, respectively. The average American Spinal Injury Association impairment scale scores had significantly improved at the final follow-up examination. The visual analog scale score had decreased from 7.8 ± 1.1 preoperatively to <2.9 ± 1.3 (P < 0.05) at 1 week postoperatively. The Oswestry disability index had decreased from 86.1 ± 8.8 preoperatively to 15.9 ± 6.4 (P < 0.05) at 1 year postoperatively. The canal stenosis index had improved from 43.4% ± 12.0% to 93.8% ± 4.8% (P < 0.05). The sagittal Cobb angle had been corrected from 17.8° ± 7.5° to 4.0° ± 1.9° (P < 0.05) and remained at 4.9° ± 2.0° (P > 0.05) at 1 year postoperatively. The sagittal index had been corrected from 16.6° ± 6.1° to 0.3° ± 4.6° (P < 0.05) and remained at 1.5° + 4.5° (P > 0.05) at 1 year postoperatively. The anterior vertebral height had increased from 49.3% ± 11.1% to 97.6% ± 6.5% (P < 0.05) and remained at 95.7% ± 6.0% (P > 0.05) at 1 year postoperatively. After implant removal, the total kyphosis correction losses were 1.5° ± 0.8° for the Cobb angle, 2.0° ± 1.1° for the sagittal index, and 3.4% ± 2.1% for the anterior vertebral height. One pullout screw and one broken rod were found in 1 patient each. CONCLUSION Minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment fixation yielded satisfactory results in decompression and immediate kyphosis correction. Additionally, this procedure resulted in maintenance of the vertebral height and prevented late correction loss after implant removal.
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Affiliation(s)
- Lin Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China.
| | - Ying Hong
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyun Hu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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