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Xue Y, Lun Z, Feng J, Dai W. Percutaneous Functional Spinal Unit Cementoplasty versus Posterior Spinal Fixation with Vertebroplasty for Symptomatic Chronic Osteoporotic Vertebral Fractures: A Retrospective Study with a 2-Year Follow up. J INVEST SURG 2023; 36:2257780. [PMID: 37852750 DOI: 10.1080/08941939.2023.2257780] [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: 05/29/2023] [Accepted: 09/04/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To compare the clinical efficacy of percutaneous functional spinal unit cementoplasty (PFSUP) and posterior spinal fixation combined with vertebroplasty (PSF + VP) for the treatment of symptomatic chronic osteoporotic vertebral fractures (SCOVFs). METHOD Thirty-one patients with SCOVFs were included in this retrospective study and divided into PFSUP (n = 14) and PSF + VP (n = 17) groups. Visual analog scores (VAS) and Oswestry Disability Index (ODI) were recorded before and after surgery and at the last follow-up. Besides, the local kyphosis angle (LKA) and sagittal vertical axis (SVA) were measured. The operation duration, number of X-ray exposures, amount of blood loss, bed rest duration, hospitalization duration, and presence of complications were recorded. RESULT The VAS, ODI, LKA, and SVA after surgery and at the last follow-up were significantly improved in both groups compared to preoperative measurements. The PFSUP group experienced shorter operation duration (78.2 ± 13.1 vs. 124.7 ± 14.7, p < 0.001), less blood loss (31.1 ± 8.1 vs. 334.7 ± 70.9, p < 0.001), more X-ray exposures (92.1 ± 14.3 vs. 29.4 ± 5.5, p < 0.001), shorter bed rest duration (12.4 ± 3.8 vs. 43.4 ± 10.0, p < 0.001), shorter hospitalization (6.6 ± 2.4 vs. 10.9 ± 2.7, p < 0.001), lower complication rate (28.5% vs. 64.7%, p < 0.05), and higher cement leakage rate (42.9% vs. 5.8%, p < 0.05) than the PSF + VP group. CONCLUSION During the treatment of SCOVFs, the combination of PFSUP and PSF + VP can restore spinal stability, improve kyphosis, and relieve pain. PFSUP can reduce blood loss and complications, early mobilization, and shorten the hospital stay, but it is associated with a higher cement leakage rate and more radiation exposure.
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Affiliation(s)
- Youdi Xue
- Department of Orthopaedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Zhifa Lun
- Department of Orthopaedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Jie Feng
- Department of Orthopaedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
| | - Weixiang Dai
- Department of Orthopaedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu Province, China
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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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Nishida N, Jiang F, Kitazumi R, Yamamura Y, Asano T, Tome R, Kumaran Y, Suzuki H, Funaba M, Ohgi J, Chen X, Sakai T. Finite element analysis of short and long posterior spinal instrumentation and fixation for different pathological thoracolumbar vertebral fractures. World Neurosurg X 2023; 19:100199. [PMID: 37151991 PMCID: PMC10160595 DOI: 10.1016/j.wnsx.2023.100199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/19/2023] [Indexed: 05/09/2023] Open
Affiliation(s)
- Norihiro Nishida
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture, 755-8505, Japan
- Corresponding author. Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture, 755-8505, Japan.
| | - Fei Jiang
- Faculty of Engineering, Yamaguchi University, 2-16-1 Tokiwadai, Ube City, Yamaguchi, 755-8611, Japan
| | - Rei Kitazumi
- Faculty of Engineering, Yamaguchi University, 2-16-1 Tokiwadai, Ube City, Yamaguchi, 755-8611, Japan
| | - Yuto Yamamura
- Faculty of Engineering, Yamaguchi University, 2-16-1 Tokiwadai, Ube City, Yamaguchi, 755-8611, Japan
| | - Takahiro Asano
- Faculty of Engineering, Yamaguchi University, 2-16-1 Tokiwadai, Ube City, Yamaguchi, 755-8611, Japan
| | - Rui Tome
- Faculty of Engineering, Yamaguchi University, 2-16-1 Tokiwadai, Ube City, Yamaguchi, 755-8611, Japan
| | - Yogesh Kumaran
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedics, The University of Toledo, Toledo, OH, USA
| | - Hidenori Suzuki
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture, 755-8505, Japan
| | - Masahiro Funaba
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture, 755-8505, Japan
| | - Junji Ohgi
- Faculty of Engineering, Yamaguchi University, 2-16-1 Tokiwadai, Ube City, Yamaguchi, 755-8611, Japan
| | - Xian Chen
- Faculty of Engineering, Yamaguchi University, 2-16-1 Tokiwadai, Ube City, Yamaguchi, 755-8611, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube City, Yamaguchi Prefecture, 755-8505, Japan
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Li QD, Yang JS, He BR, Liu TJ, Gao L, Chai X, Tian X, Hao DJ. Risk factors for proximal junctional kyphosis after posterior long-segment internal fixation for chronic symptomatic osteoporotic thoracolumbar fractures with kyphosis. BMC Surg 2022; 22:189. [PMID: 35568832 PMCID: PMC9107743 DOI: 10.1186/s12893-022-01598-9] [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: 01/01/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to analyze the risk factors for proximal junctional kyphosis (PJK) for patients with chronic symptomatic osteoporotic thoracolumbar fractures (CSOTLF) and kyphosis who underwent long-segment internal fixation.
Methods We retrospectively reviewed the records of patients with CSOTLF complicated with kyphosis who underwent posterior multilevel internal fixation in our hospital between January 2013 and January 2020. The patients’ age, sex, body mass index (BMI), bone mineral density (BMD), smoking status, cause of injury, comorbidities, injury segments, and American Spinal Injury Association (ASIA) grading non-surgical data; posterior ligament complex (PLC) injury, upper and lower instrumented vertebral position (UIV and LIV, respectively), number of fixed segments surgical data, proximal junctional angle (PJA), sagittal vertebral axis (SVA), pelvic incidence (PI), lumbar lordosis (LL), pelvic incidence-lumbar lordosis mismatch (PI-LL), pelvic tilt (PT), and sacral slope (SS) surgical indicators were collected. Patients were divided into postoperative PJK and non-PJK groups. Results This study included 90 patients; among them, 30 (31.58%) developed PJK postoperatively. All patients were followed up for > 24 months (mean 32.5 months). Univariate analysis showed significant differences in age, BMI, BMD, PLC injury, UIV, and LIV fixation position, number of fixation stages, and preoperative PJA, SVA, PI-LL, and SS between the two groups (P < 0.05). Additionally, no significant differences were observed in sex, smoking, cause of injury, complications, injury segment ASIA grade, and preoperative PT between the two groups (P > 0.05). Multifactorial logistic regression analysis showed that age > 70 years (OR = 32.279, P < 0.05), BMI > 28 kg/m2 (OR = 7.876, P < 0.05), BMD T value < − 3.5 SD (OR = 20.836, P < 0.05), PLC injury (OR = 13.981, P < 0.05), and preoperative PI-LL > 20° (OR = 13.301, P < 0.05) were risk factors for PJK after posterior long-segment internal fixation in elderly patients with CSOTLF complicated with kyphosis. Conclusion CSOTLF patients undergoing posterior long segment internal fixation are prone to PJK, and age > 70 years, BMI > 28 kg/m2, BMD T value < − 3.5 SD, preoperative PI-LL > 20° and PLC injury may increase their risk.
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Affiliation(s)
- Qing-Da Li
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Jun-Song Yang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Bao-Rong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Tuan-Jiang Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Lin Gao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Xin Chai
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Xin Tian
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China
| | - Ding-Jun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China.
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Yaman O, Zileli M, Sharif S. Decompression and fusion surgery for osteoporotic vertebral fractures: WFNS Spine Committee Recommendations. J Neurosurg Sci 2022; 66:327-334. [PMID: 35380203 DOI: 10.23736/s0390-5616.22.05640-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTODUCTION Osteoporotic vertebral fractures (OVF) are common due to aging populations. Their clinical management remains controversial. Although conservative approaches are sufficient in most cases, there are certain conditions where decompression or fusion surgery are necessary. This manuscript aims to clarify the indications and types of surgeries for OVF. EVIDENCE ACQUISITION A Medline and Pubmed search spanning the period between 2010 and 2020 was performed using the keywords "osteoporotic vertebral fractures and decompression surgery" and "osteoporotic vertebral fractures and fusion surgery". In addition, we reviewed up-to-date information on decompression and fusion in osteoporotic vertebral fracture (OVF) to reach an agreement in two consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee that was held in January and February 2021. The Delphi method was utilized to improve the validity of the questionnaire. EVIDENCE SYNTHESIS A total of 19 studies examining decompression and fusion surgery in OVF were reviewed. Literature supports the statement that decompression and fusion surgery are necessary for progressive neurological deficits after OVF. The Spine Section of the German Society for Orthopedics and Trauma (DGOU) classification revealed that it might help make surgical decisions. We also noted that in patients planning to undergo surgery to correct significant kyphosis after OVF, several techniques, including multilevel fixation, cement augmentation, preservation of sagittal balance, and avoiding termination at the apex of kyphosis are necessary to prevent complications. Additionally, it became clear that there is no consensus to choose the type of open surgery (anterior, posterior, combined, using cement or bone or vertebral body cage, the levels, and kind of instrumentation). The current literature indicated that implant failure in the osteoporotic spine is a common complication, and many techniques have been described to prevent implant failure in the osteoporotic spine. However, the superiority of one method over another is unclear. CONCLUSIONS Open surgery for osteoporotic vertebral fractures should be considered if neurologic deficits and significant painful kyphosis. The apparent indications of surgery and most ideal surgical technique for OVF remain unclear in the literature; therefore, the decision must be individualized.
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Affiliation(s)
- Onur Yaman
- Memorial Bahçelievler Spine Center, Istanbul, Turkey -
| | - Mehmet Zileli
- Ege University Neurosurgery Department, Izmir, Turkey
| | - Salman Sharif
- Neurosurgery Department, Liaquat Hospital, Karachi, Pakistan
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Ronzani LD, Bang H, Kock KS, Menegaz PDS, Martins RO, Back Netto M. THORACOLUMBAR FUSION IN THE UNIFIED HEALTH SYSTEM: PRE-COVID-19 TEMPORAL. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222102257395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the temporal trends of thoracolumbar fusion procedures performed by the United Health System in Brazil from 2009 to 2019. Methods: This was an observational ecological study based on data collected from the information systems under the aegis of DATASUS, especially the Hospital Information System, which manages the Hospital Admission Authorizations (Autorizações de Internação Hospitalar - AIHs). All patients who had undergone the procedures of interest, that is, elective and emergency short and long thoracolumbar arthrodeses, were included. The temporal trends of the procedures performed in Brazil and in its five regions were calculated using polynomial regression. Results: The temporal trend of elective thoracolumbar arthrodesis decreased, while that of emergency arthrodesis increased, with the peak in 2015, followed by a marked decline. Short fusions were more frequent in both elective and emergency modalities, and the South and Central-West Regions had the highest indices of procedures per million inhabitants during the entire 2009 to 2019 period. Conclusions: The temporal trends of thoracolumbar fusions performed by SUS have decreased over the last decade, a phenomenon which may be explained by the growing criticism of indications of the procedure in the current literature. Level of evidence III; Retrospective Comparative Study.
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Affiliation(s)
| | - Hannah Bang
- Universidade do Sul de Santa Catarina, Brazil
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Du X, Jiang G, Zhu Y, Luo W, Ou Y. A predictive scoring system for proximal junctional kyphosis after posterior internal fixation in elderly patients with chronic osteoporotic vertebral fracture: A single-center diagnostic study. Front Endocrinol (Lausanne) 2022; 13:923778. [PMID: 35937792 PMCID: PMC9354091 DOI: 10.3389/fendo.2022.923778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To establish a predictive scoring system for proximal junctional kyphosis (PJK) after posterior internal fixation in elderly patients with chronic osteoporotic vertebral fracture (COVF). MATERIALS AND METHODS The medical records of 88 patients who were diagnosed with COVF and underwent posterior internal fixation in our hospital from January 2013 to December 2017 were retrospectively analyzed. The included patients were divided into two groups according to whether they suffered PJK after surgery, namely, the PJK group (25 cases) and non-PJK group (63 cases). The following clinical characteristics were recorded and analyzed: age, gender, body mass index (BMI), bone mineral density (BMD), smoking history, fracture segment, proximal junction angle, sagittal vertebral axis, pelvic incidence (PI)-lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), posterior ligamentous complex (PLC) injury, upper instrumented vertebra, lower instrumented vertebra, and the number of fixed segments. The prevalence of these clinical characteristics in the PJK group was evaluated, and the scoring system was established using logistic regression analysis. The performance of the scoring system was also prospectively validated. RESULTS The predictive scoring system was established based on five clinical characteristics confirmed as significant predictors of PJK, namely, age > 70 years, BMI > 28 kg/m2, BMD < -3.5 SD, preoperative PI-LL > 20°, and PLC injury. PJK showed a significantly higher score than non-PJK (7.80 points vs. 2.83 points, t=9.556, P<0.001), and the optimal cutoff value for the scoring system was 5 points. The sensitivity and specificity of the scoring system for predicting postoperative PJK were 80.00% and 88.89%, respectively, in the derivation set and 75.00% and 80.00% in the validation set. CONCLUSION The predictive scoring system was confirmed with satisfactory sensitivity and specificity in predicting PJK after posterior internal fixation in elderly COVF patients. The risk of postoperative PJK in patients with a score of 6-11 is high, while the score of 0-5 is low.
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Affiliation(s)
- Xing Du
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
| | - Guanyin Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
| | - Yong Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
| | - Wei Luo
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
| | - Yunsheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, China
- *Correspondence: Yunsheng Ou,
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