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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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Nhã LH, Hùng KĐ. Efficacy of cement-augmented pedicle screw fixation for osteoporotic mid-thoracic vertebral fractures. Surg Neurol Int 2023; 14:378. [PMID: 37941622 PMCID: PMC10629338 DOI: 10.25259/sni_751_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/30/2023] [Indexed: 11/10/2023] Open
Abstract
Background Osteoporotic mid-thoracic vertebral fractures (OmTVF), often result in severe pain, and neurological deficits secondary to cord compression. Cement-augmented pedicle screw (CaPS) fixation with posterior spinal decompression (PSD) offers simultaneous decompression with stabilization of these osteoporotic vertebral fractures. Methods The study involved 32 patients (2022-2023) with T8-T10 osteoporotic vertebral compression fractures resulting in cord compression. All patients underwent CaPS surgery with PSD. Pain reduction was measured using the visual analog scale (VAS), and outcomes with the Oswestry Disability Index, and the American Spinal Injury Association Grades. The local kyphotic angle was also tracked with computed tomography studies performed 1, 3, and 6 months post-operatively. Results The average pre-operative VAS score was 8.56 mm; this decreased at 1, 3, and 6 months post-operatively to 2.72 mm, 2.03 mm, and 1.44 mm, respectively. In addition, 31 of 32 patients fully recovered within 6 postoperative months. Conclusion For 31 of 32 patients with T8-T10 osteoporotic vertebral fractures, CaPS fixation with PSD successfully alleviated pain and resulted in significant post-operative neurological recovery.
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Affiliation(s)
- Lê Hoàng Nhã
- Department of Neurosurgery and Spine Surgery, Ha Noi Medical University, Ha Nội, Vietnam
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Spiegl UJA, Schenk P, Schnake KJ, Ullrich BW, Osterhoff G, Scheyerer MJ, Schmeiser G, Bäumlein M, Scherer MA, Müller M, Sprengel K, Liepold K, Schramm S, Baron HC, Siekmann H, Schwarz F, Franck A, Zimmermann V, Katscher S. Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Body Fractures With Deformation of Both Endplates With or Without Posterior Wall Involvement (OF 4): Short-Term Results from the Prospective EOFTT Multicenter Study. Global Spine J 2023; 13:36S-43S. [PMID: 37084347 PMCID: PMC10177306 DOI: 10.1177/21925682221140831] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2023] Open
Abstract
STUDY DESIGN Multicenter prospective cohort study. OBJECTIVE To analyse therapeutical strategies applied to osteoporotic thoracolumbar OF 4 injuries, to assess related complications and clinical outcome. METHODS A multicenter prospective cohort study (EOFTT) including 518 consecutive patients who were treated for an Osteoporotic vertebral compression fracture (OVCF). For the present study, only patients with OF 4 fractures were analysed. Outcome parameters were complications, Visual Analogue Scale, Oswestry Disability Questionnaire, Timed Up & Go test, EQ-5D 5L, and Barthel Index after a minimum follow-up of 6 weeks. RESULTS A total of 152 (29%) patients presented with OF 4 fractures with a mean age of 76 years (range 41-97). The most common treatment was short-segment posterior stabilization (51%; hybrid stabilization in 36%). Mean follow up was 208 days (±131 days), mean ODI was 30 ± 21. Dorsoventral stabilized patients were younger compared to the other groups (P < .001) and had significant better TuG compared to hybrid stabilization (P = .049). The other clinical outcomes did not differ in the therapy strategies (VAS pain: P = 1.000, ODI: P > .602, Barthel: P > .252, EQ-5D 5L index value: P > .610, VAS-EQ-5D 5L: P = 1.000). The inpatient complication rate was 8% after conservative and 16% after surgical treatment. During follow-up period 14% of conservatively treated patients and 3% of surgical treated patients experienced neurological deficits. CONCLUSIONS Conservative therapy of OF 4 injuries seems to be viable option in patients with only moderate symptoms. Hybrid stabilization was the dominant treatment strategy leading to promising clinical short-term results. Stand-alone cement augmentation seems to be a valid alternative in selected cases.
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Affiliation(s)
- Ulrich J A Spiegl
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Philipp Schenk
- Department of Science, Research and Education, BG Clinic Bergmannstrost Halle, Halle, Germany
| | - Klaus John Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| | - Bernhard W Ullrich
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Jena, Germany
- Department of Trauma and Reconstructive Surgery, BG Clinic Bergmannstrost Halle, Halle, German
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Max J Scheyerer
- Department of Orthopaedic and Traumatology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gregor Schmeiser
- Department of Spine Surgery, Schoen-Klinik Hamburg-Eilbek, Hamburg, Germany
| | - Martin Bäumlein
- Center for Orthopaedics and Trauma Surgery, University Hospital Giessen and Marburg GmbH, Marburg, Germany
| | - Michael A Scherer
- Lehrkörper Medizinische Fakultät der, Technischen Universität München (Med. Fak. TUM), Munich, Germany
| | - Michael Müller
- Department of Orthopedic and Trauma Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Germany
| | - Kai Sprengel
- University of Lucerne, Hirslanden Clinic St. Anna, Lucerne, Switzerland
- Department of Trauma, University Hospital Zurich (USZ), University of Zurich (UZH), Zurich, Switzerland
| | - Katja Liepold
- Department of Spine Surgery, Thuringia Clinic "Georgius Agricola" Saalfeld, Teaching Hospital of the University of Jena, Saalfeld, Germany
| | - Simon Schramm
- Department of Trauma Surgery, University Hospital Erlangen, Erlangen, Germany
| | - H-Christopher Baron
- Department for Paraplegia and Spine Surgery, BG Trauma Center, Tuebingen, Germany
| | - Holger Siekmann
- Clinic of Trauma-, Hand- and Reconstruction Surgery,AMEOS-Clinic Halberstadt, Halberstadt, Germany
| | - Falko Schwarz
- Department of Neurosurgery, - Friedrich Schiller University, Jena University Hospital, Jena, Germany
| | - Alex Franck
- Department of Orthopaedics and Trauma Surgery, Regiomed Klinikum Coburg, Germany
| | - Volker Zimmermann
- Department of Trauma and Orthopedic Surgery, Klinikum Traunstein, Traunstein, Germany
| | - Sebastian Katscher
- Interdisciplinary Center for Spine and Neurotrauma, Sana Klinikum Borna, Borna, Germany
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Tani Y, Tanaka T, Kawashima K, Masada K, Paku M, Ishihara M, Adachi T, Taniguchi S, Ando M, Saito T. A triple minimally invasive surgery combination for subacute osteoporotic lower lumbar vertebral collapse with neurological compromise: a potential alternative to the vertebral corpectomy/expandable cage strategy. Neurosurg Focus 2023; 54:E10. [PMID: 36587407 DOI: 10.3171/2022.10.focus22609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/14/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Acute/subacute osteoporotic vertebral collapses (OVCs) in the lower lumbar spine with neurological compromise, although far less well documented than those in the thoracolumbar junction, may often pose greater treatment challenges. The authors clarified the utility of 3 familiar combined techniques of minimally invasive surgery for this condition as an alternative to the corpectomy/expandable cage strategy. METHODS This report included the authors' first 5 patients with more than 2 years (range 27-48 months) of follow-up. The patients were between 68 and 91 years of age, and had subacute painful L4 OVC with neurological compromise and preexisting lumbar spinal stenosis. The authors' single-stage minimally invasive surgery combination consisted of the following: step 1, balloon kyphoplasty for the L4 OVC to restore its strength, followed by L4-percutaneous pedicle screw (PPS) placement with patients in the prone position; step 2, tubular lateral lumbar interbody fusion (LLIF) at the adjacent disc space involved with endplate injury, with patients in the lateral position; and step 3, supplemental PPS-rod fixation with patients in the prone position. RESULTS Estimated blood loss ranged from 20 to 72 mL. Neither balloon kyphoplasty-related nor LLIF-related potentially serious complications occurred. With CT measurements at the 9 LLIF levels, the postoperative increases averaged 3.5 mm in disc height and 3.7 mm in bilateral foraminal heights, which decreased by only 0.2 mm and 0 mm at the latest evaluation despite their low bone mineral densities, with a T-score of -3.8 to -2.6 SD. Canal compromise by fracture retropulsion decreased from 33% to 23% on average. As indicated by MRI measurements, the dural sac progressively enlarged and the ligamentum flavum increasingly shrank over time postoperatively, consistent with functional improvements assessed by the physician-based, patient-centered measures. CONCLUSIONS The advantages of this method over the corpectomy/expandable cage strategy include the following: 1) better anterior column stability with a segmentally placed cage, which reduces stress concentration at the cage footplate-endplate interface as an important benefit for patients with low bone mineral density; 2) indirect decompression through ligamentotaxis caused by whole-segment spine lengthening with LLIF, pushing back both the retropulsed fragments and the disc bulge anteriorly and unbuckling the ligamentum flavum to diminish its volume posteriorly; and 3) eliminating the need for segmental vessel management and easily bleeding direct decompressions. The authors' recent procedural modification eliminated step 3 by performing loose PPS-rod connections in step 1 and their tight locking after LLIF in step 2, reducing to only once the number of times the patient was repositioned.
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Affiliation(s)
- Yoichi Tani
- Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan
| | - Takahiro Tanaka
- Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan
| | - Koki Kawashima
- Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan
| | - Kohei Masada
- Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan
| | - Masaaki Paku
- Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan
| | - Masayuki Ishihara
- Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan
| | - Takashi Adachi
- Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan
| | | | - Muneharu Ando
- Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan
| | - Takanori Saito
- Department of Orthopaedic Surgery, Kansai Medical University, Osaka, Japan
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Jang HD, Kim EH, Lee JC, Choi SW, Kim HS, Cha JS, Shin BJ. Management of Osteoporotic Vertebral Fracture: Review Update 2022. Asian Spine J 2022; 16:934-946. [PMID: 36573301 PMCID: PMC9827207 DOI: 10.31616/asj.2022.0441] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
A vertebral fracture is the most common type of osteoporotic fracture. Osteoporotic vertebral fractures (OVFs) cause a variety of morbidities and deaths. There are currently few "gold standard treatments" outlined for the management of OVFs in terms of quantity and quality. Conservative treatment is the primary treatment option for OVFs. The treatment of pain includes short-term bed rest, analgesic medication, anti-osteoporotic medications, exercise, and a brace. Numerous reports have been made on studies for vertebral augmentation (VA), including vertebroplasty and kyphoplasty. There is still debate and controversy about the effectiveness of VA in comparison with conservative treatment. Until more robust data are available, current evidence does not support the routine use of VA for OVF. Despite the fact that the majority of OVFs heal without surgery, 15%-35% of patients with an unstable fracture, persistent intractable back pain, or severely collapsed vertebra that causes a neurologic deficit, kyphosis, or chronic pseudarthrosis frequently require surgery. Because no single approach can guarantee the best surgical outcomes, customized surgical techniques are required. Surgeons must stay current on developments in the osteoporotic spine field and be open to new treatment options. Osteoporosis management and prevention are critical to lowering the risk of future OVFs. Clinical studies on bisphosphonate's effects on fracture healing are lacking. Teriparatide was intermittently administered, which dramatically improved spinal fusion and fracture healing while lowering mortality risk. According to the available literature, there are no standard management methods for OVFs. More multimodal approaches, including conservative and surgical treatment, VA, and medications that treat osteoporosis and promote fracture healing, are required to improve the quality of the majority of guidelines.
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Affiliation(s)
- Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eung-Ha Kim
- Department of Orthopaedic Surgery, Dongkang Hospital, Ulsan, Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea,Corresponding author: Jae Chul Lee Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea Tel: +82-32-621-5114, Fax: +82-32-621-5018, E-mail:
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Hak Soo Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Joong-Suk Cha
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Osteoporosis as a Risk Factor for Intraoperative Complications and Long-term Instrumentation Failure in Patients With Scoliotic Spinal Deformity. Spine (Phila Pa 1976) 2022; 47:1435-1442. [PMID: 36174132 DOI: 10.1097/brs.0000000000004418] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective review study. OBJECTIVE This study aims to determine the effect of osteoporosis on spine instrumentation. SUMMARY OF BACKGROUND DATA Osteoporosis is a common skeletal pathology that affects systemic cortical bone maintenance and remodeling. This disease accelerates the degeneration of the spine, often necessitating spinal surgery for progressive vertebral deformity, pathologic fracture, bony canal stenosis, and/or neural element decompression. There is a paucity of literature describing the role of osteoporosis as it relates to both perioperative complications and outcomes after spine fusion surgery. MATERIALS AND METHODS A retrospective review was conducted of a prospectively maintained database for patients undergoing spine surgery between January 1, 2006 and October 3, 2017. Inclusion criteria included age 18 years and above and surgery performed for the correction of thoracolumbar scoliosis. Data collected included various demographic, clinical, and operative variables. RESULTS A total of 532 patients met inclusion criteria, including 144 (27%) patients with a diagnosis of osteoporosis. Osteoporosis was significantly associated with increased blood volume loss (P=0.003). Postoperatively, osteoporosis was associated with increased rates of instrumentation failure (19% vs. 10%; P=0.008) and the need for revision surgery (33% vs. 16%; P<0.001). Multivariate analysis confirmed osteoporosis to be an independent risk factor for increased mean number of spinal segments fused (P<0.05), mean blood volume loss (P<0.05), rate of postoperative deep venous thrombosis/pulmonary embolism (P<0.05), rate of instrumentation failure (P<0.05), and need for revision surgery (P<0.05). CONCLUSION Osteoporosis is a significant risk factor for instrumentation failure and need for revision surgery following arthrodesis for scoliosis correction. Furthermore, patients with osteoporosis have a significantly higher risk of intraoperative blood volume loss and postoperative thromboembolic events.
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Takeuchi T, Yamagishi K, Konishi K, Sano H, Takahashi M, Ichimura S, Kono H, Hasegawa M, Hosogane N. Radiological Evaluation of Combined Anteroposterior Fusion with Vertebral Body Replacement Using a Minimally Invasive Lateral Approach for Osteoporotic Vertebral Fractures: Verification of Optimal Surgical Procedure. J Clin Med 2022; 11:jcm11030629. [PMID: 35160080 PMCID: PMC8836420 DOI: 10.3390/jcm11030629] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/29/2022] Open
Abstract
The combined anteroposterior fusion with vertebral body replacement (VBR) using a wide footplate expandable cage with a minimally invasive lateral approach has been widely used for pseudoarthrosis after osteoporotic vertebral fractures. The purpose of this study is to evaluate the radiological results of combined anteroposterior surgery using VBR and to recommend the optimal procedure. Thirty-eight elderly patients were included in this study. The mean preoperative local kyphosis angle was 29.3°, and the mean correction loss angle was 6.3°. Cage subsidence was observed in ten patients (26.3%), and UIV or LIV fracture in twelve patients (31.6%). Patients with cage subsidence were compared to those without cage subsidence to determine the causal factors. The mean number of fixed vertebrae was 5.4 vertebrae with cage subsidence and 7.4 vertebrae without cage subsidence. In addition, to precisely clarify the optimal number of fixed vertebrae, those patients with two above–two below fixation were compared to those with less than two above–two below fixation, which revealed that the correction loss angle was significantly less in two above–two below fixation (p = 0.016). Based on these results, we recommend at least two above–two below fixation with VBR to minimize the correction loss angle and prevent cage subsidence.
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Affiliation(s)
- Takumi Takeuchi
- Department of Orthopedic Surgery, Kyorin University, Tokyo 181-8611, Japan; (T.T.); (K.K.); (H.S.); (M.T.); (S.I.)
| | - Kenichiro Yamagishi
- Department of Orthopedic Surgery, Higashiyamato Hospital, Tokyo 207-0014, Japan;
| | - Kazumasa Konishi
- Department of Orthopedic Surgery, Kyorin University, Tokyo 181-8611, Japan; (T.T.); (K.K.); (H.S.); (M.T.); (S.I.)
| | - Hideto Sano
- Department of Orthopedic Surgery, Kyorin University, Tokyo 181-8611, Japan; (T.T.); (K.K.); (H.S.); (M.T.); (S.I.)
| | - Masato Takahashi
- Department of Orthopedic Surgery, Kyorin University, Tokyo 181-8611, Japan; (T.T.); (K.K.); (H.S.); (M.T.); (S.I.)
| | - Shoichi Ichimura
- Department of Orthopedic Surgery, Kyorin University, Tokyo 181-8611, Japan; (T.T.); (K.K.); (H.S.); (M.T.); (S.I.)
| | - Hitoshi Kono
- Department of Orthopedic Surgery, Keiyu Orthopedic Hospital, Tatebayashi 374-0013, Japan;
| | - Masaichi Hasegawa
- Department of Orthopedic Surgery, Kugayama Hospital, Tokyo 157-0061, Japan;
| | - Naobumi Hosogane
- Department of Orthopedic Surgery, Kyorin University, Tokyo 181-8611, Japan; (T.T.); (K.K.); (H.S.); (M.T.); (S.I.)
- Correspondence: ; Tel.: +81-422-47-5511
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Doi T, Kozuma R, Arima J. Osteoporotic Thoracolumbar Vertebral Fractures With Neurological Deficit Treated by Balloon Kyphoplasty Augmented with Newly Developed Minimally Invasive Posterior Hook Stabilization. Cureus 2021; 13:e20505. [PMID: 34950559 PMCID: PMC8687599 DOI: 10.7759/cureus.20505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/18/2022] Open
Abstract
Most osteoporotic vertebral fractures (OVFs) are treated conservatively, but surgery is often indicated for residual pain, neuropathy, or severe deformity. OVFs tend to develop in elderly patients, so less invasive surgery is desirable. Surgery is mainly performed to stabilize the fractured vertebral body. Percutaneous cement augmentation, such as via balloon kyphoplasty (BKP), has produced satisfactory results as a surgical method for managing OVFs. Posterior fixation with implants is often performed with or without cement augmentation when stronger fixation is considered necessary for OVFs with local kyphosis and angular instability. Pedicle screws (PSs) are widely used as an implant for posterior fixation, but given the risk of backing out in bones with severe osteoporosis, several measures have been taken to increase the strength such as by adding hooks. In cases of osteoporosis, hooks that can use cortical bone as an anchor are considered more useful than PS but are rarely used in minimally invasive surgery. We developed a minimally invasive posterior hook stabilization approach to directly stabilize the posterior spinal components as a new augmentation method for BKP and applied it to four cases of thoracolumbar OVF with neurological symptoms. The operation time was about 60 minutes, including BKP, and the estimated blood loss was about 10 ml. No postoperative implant problems occurred, and in all cases, neurological symptoms, such as buttocks and leg pain, were alleviated at an early stage after surgery. One patient had a postoperative adjacent vertebral body fracture that was conservatively treatable. Minimally invasive posterior hook stabilization, which we developed as a way of augmenting BKP, was considered useful for managing vertebral body fractures of the thoracolumbar spine with local kyphosis and angular instability.
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Affiliation(s)
- Toshio Doi
- Orthopaedic Surgery, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, JPN
| | - Ryutaro Kozuma
- Orthopaedic Surgery, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, JPN
| | - Junichi Arima
- Orthopaedic Surgery, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, JPN
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Terai H, Takahashi S, Yasuda H, Konishi S, Maeno T, Kono H, Matsumura A, Namikawa T, Kato M, Hoshino M, Tamai K, Toyoda H, Suzuki A, Nakamura H. Direct Lateral Corpectomy and Reconstruction Using an Expandable Cage Improves Local Kyphosis but Not Global Sagittal Alignment. J Clin Med 2021; 10:jcm10174012. [PMID: 34501460 PMCID: PMC8432512 DOI: 10.3390/jcm10174012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/30/2021] [Accepted: 09/03/2021] [Indexed: 01/07/2023] Open
Abstract
Recently, an expandable cage equipped with rectangular footplates has been used for anterior vertebral replacement in osteoporotic vertebral fracture (OVF). However, the postoperative changes in global alignment have not been elucidated. The purpose of this study was to evaluate local and global spinal alignment after anterior and posterior spinal fixation (APSF) using an expandable cage in elderly OVF patients. This retrospective multicenter review assessed 54 consecutive patients who underwent APSF for OVF. Clinical outcomes were compared between postoperative sagittal vertical axis (SVA) > 95 mm and ≤95 mm groups to investigate the impact of malalignment. SVA improved by only 18.7 mm (from 111.8 mm to 93.1 mm). VAS score of back pain at final follow-up was significantly higher in patients with SVA > 95 mm than SVA ≤ 95 mm (42.4 vs. 22.6, p = 0.007). Adjacent vertebral fracture after surgery was significantly more frequent in the SVA > 95 mm (37% vs. 11%, p = 0.038). Multiple logistic regression showed significantly increased OR for developing adjacent vertebral fracture (OR = 4.76, 95% CI 1.10–20.58). APSF using the newly developed cage improves local kyphotic angle but not SVA. The main cause for the spinal malalignment after surgery was postoperative development of adjacent vertebral fractures.
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Affiliation(s)
- Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
| | - Shinji Takahashi
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
- Correspondence: ; Tel.: +81-06-6645-3851
| | - Hiroyuki Yasuda
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan; (H.Y.); (S.K.)
| | - Sadahiko Konishi
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka 545-0053, Japan; (H.Y.); (S.K.)
| | - Takafumi Maeno
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka 579-8026, Japan; (T.M.); (H.K.)
| | - Hiroshi Kono
- Department of Orthopaedic Surgery, Ishikiri Seiki Hospital, Osaka 579-8026, Japan; (T.M.); (H.K.)
| | - Akira Matsumura
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka 534-0021, Japan; (A.M.); (T.N.); (M.K.)
| | - Takashi Namikawa
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka 534-0021, Japan; (A.M.); (T.N.); (M.K.)
| | - Minori Kato
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka 534-0021, Japan; (A.M.); (T.N.); (M.K.)
| | - Masatoshi Hoshino
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
| | - Hiromitsu Toyoda
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
| | - Akinobu Suzuki
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan; (H.T.); (M.H.); (K.T.); (H.T.); (A.S.); (H.N.)
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10
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Nakajima H, Kubota A, Watanabe S, Honjoh K, Matsumine A. Clinical and imaging features of surgically treated low lumbar osteoporotic vertebral collapse in patients with Parkinson's disease. Sci Rep 2021; 11:14235. [PMID: 34244599 PMCID: PMC8270950 DOI: 10.1038/s41598-021-93798-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 07/01/2021] [Indexed: 01/18/2023] Open
Abstract
Osteoporosis and Parkinson's disease (PD) are age-related diseases, and surgery for osteoporotic vertebral collapse (OVC) in PD patients become more common. OVC commonly affects the thoracolumbar spine, but low lumbar OVC is frequent in patients with lower bone mineral density (BMD). The aim of this study was to identify differences in clinical and imaging features of low lumbar OVC with or without PD and to discuss the appropriate treatment. The subjects were 43 patients with low lumbar OVC below L3 who were treated surgically, including 11 patients with PD. The main clinical symptoms were radicular pain in non-PD cases and a cauda equina sign in PD cases. Rapid progression and destructive changes of OVC were seen in patients with PD. The morphological features of OVC were flat-type in non-PD cases with old compression fracture, and destruction-type in PD cases without old compression fracture. Progression of PD was associated with decreased lumbar lordosis, lower lumbar BMD, and severe sarcopenia. High postoperative complication rates were associated with vertebral fragility and longer fusion surgery. Progression of postural instability as a natural course of PD may lead to mechanical stress and instrumentation failure. Invasive long-fusion surgery should be avoided for single low lumbar OVC.
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Affiliation(s)
- Hideaki Nakajima
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Arisa Kubota
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Shuji Watanabe
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kazuya Honjoh
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Akihiko Matsumine
- Department of Orthopaedics and Rehabilitation Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuoka Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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11
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Terai H, Takahashi S, Yasuda H, Konishi S, Maeno T, Kono H, Matsumura A, Namikawa T, Kato M, Hoshino M, Tamai K, Toyoda H, Suzuki A, Nakamura H. Differences in surgical outcome after anterior corpectomy and reconstruction with an expandable cage with rectangular footplates between thoracolumbar and lumbar osteoporotic vertebral fracture. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 6:100071. [PMID: 35141636 PMCID: PMC8819965 DOI: 10.1016/j.xnsj.2021.100071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/24/2022]
Abstract
Background Anterior and posterior spinal fixation (APSF) can provide rigid structural anterior column support in patients with osteoporotic vertebral fracture (OVF). A new rectangular footplate designed based on biomechanical studies of endplates provides better resistance to subsidence. However, differences in characteristics exist between the thoracolumbar and lower lumbar spine. The purpose of this study was to evaluate the surgical outcomes following APSF using an expandable cage with rectangular footplates in the thoracolumbar/lumbar region. Methods Consecutive patients who underwent APSF for OVF at multiple centers were retrospectively reviewed. Clinical and radiographic evaluations were performed by dividing the patients into thoracolumbar (TL, T10–L2) and lumbar (L, L3–L5) groups. Surgical indications were incomplete neurologic deficit or intractable back pain with segmental spinal instability. Surgical outcomes including the Japanese Orthopaedic Association (JOA) score and reoperation rate were compared between TL and L groups. Results Sixty-nine patients were followed-up for more than 12 months and analyzed. Operative intervention was required for 35 patients in the TL group and 34 patients in the L group. Mean ages in the TL and L groups were 76.5 years and 75.1 years, respectively. Intra-vertebral instability was more frequent in the TL group (p<0.001). Screw fixation range was significantly longer in the TL group (p=0.012). The rate of cage subsidence did not differ significantly between the TL group (46%) and L group (44%). Reoperation rate tended to be higher in the TL group (p=0.095). Improvement ratio of JOA score was significantly better in the L group (60%) than in the TL group (46.9%, p=0.029). Conclusion APSF using an expandable cage was effective to treat OVF at both lumbar and thoracolumbar levels. However, the improvement ratio of the JOA score was better in the L group than in the TL group.
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12
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Bao LS, Wu W, Wang X, Zhong XH, Wang LX, Wang H. Clinical Observation of Intraosseous Anesthesia in Percutaneous Kyphoplasty. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5528073. [PMID: 34122783 PMCID: PMC8189784 DOI: 10.1155/2021/5528073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
Objective Percutaneous kyphoplasty (PKP) is an effective minimally invasive technique in spine surgery in recent years. General anesthesia and local anesthesia are the main ways of anesthesia in PKP, and epidural anesthesia is also applied to PKP to some extent. However, all these three anesthetic methods have their respective advantages and disadvantages. It is essential to compare and evaluate the effects of different anesthesia methods on PKP for treating spinal fractures. Method A total of 45 patients (53 vertebral bodies were included) were divided into two groups. Group A included 24 patients (29 vertebral bodies) with an average of 71 years old and Group B included 21 patients (24 vertebral bodies) with an average of 74 years old. Visual analogue scale (VAS) scores were recorded preoperatively; balloon expansion and bone cement injection were conducted intraoperatively. Then, they were recorded immediately after operation, 6 h postoperatively, to assess the pain level of the patient. Moreover, hospitalization time (days), operation duration (minutes), and bone cement injection amount (mL) had also been recorded. Results There was no significant difference in preoperative general information and VAS score. However, the VAS scores were statistically significant at both the moment of balloon expansion and injection of bone cement. At the moment of immediate postoperation, the VAS scores showed no statistically significant difference, while it showed a statistically significant difference 6 h postoperatively. Conclusion The anesthesia method by injection of 1% lidocaine hydrochloride (5 ml) into vertebral body can effectively relieve patients' pain in intraoperation and postoperation.
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Affiliation(s)
- Li-Shuai Bao
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Wei Wu
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Xin Wang
- Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu 610000, China
| | - Xi-Hong Zhong
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Lin-Xiu Wang
- The Second Affiliated Hospital of Chengdu Medical College (China National Nuclear Corporation 416 Hospital), Chengdu 610000, China
| | - Hong Wang
- The First Affiliated Hospital of Dalian Medical University, Dalian 116000, China
- Dalian Municipal Central Hospital, Dalian, China
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13
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Fukuda K, Katoh H, Takahashi Y, Kitamura K, Ikeda D. Minimally invasive anteroposterior combined surgery using lateral lumbar interbody fusion without corpectomy for treatment of lumbar spinal canal stenosis associated with osteoporotic vertebral collapse. J Neurosurg Spine 2021; 35:154-162. [PMID: 34049282 DOI: 10.3171/2020.10.spine201293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Various reconstructive surgical procedures have been described for lumbar spinal canal stenosis (LSCS) with osteoporotic vertebral collapse (OVC); however, the optimal surgery remains controversial. In this study, the authors aimed to report the clinical and radiographic outcomes of their novel, less invasive, short-segment anteroposterior combined surgery (APCS) that utilized oblique lateral interbody fusion (OLIF) and posterior fusion without corpectomy to achieve decompression and reconstruction of anterior support in patients with LSCS-OVC. METHODS In this retrospective study, 20 patients with LSCS-OVC (mean age 79.6 years) underwent APCS and received follow-up for a mean of 38.6 months. All patients were unable to walk without support owing to severe low-back and leg pain. Cleft formations in the fractured vertebrae were identified on CT. APCS was performed on the basis of a novel classification of OVC into three types. In type A fractures with a collapsed rostral endplate, combined monosegment OLIF and posterior spinal fusion (PSF) were performed between the collapsed and rostral adjacent vertebrae. In type B fractures with a collapsed caudal endplate, combined monosegment OLIF and PSF were performed between the collapsed and caudal adjacent vertebrae. In type C fractures with severe collapse of both the rostral and caudal endplates, bisegment OLIF and PSF were performed between the rostral and caudal adjacent vertebrae, and pedicle screws were also inserted into the collapsed vertebra. Preoperative and postoperative clinical and radiographical status were reviewed. RESULTS The mean number of fusion segments was 1.6. Walking ability improved in all patients, and the mean Japanese Orthopaedic Association score for recovery rate was 65.7%. At 1 year postoperatively, the mean preoperative Oswestry Disability Index of 65.6% had significantly improved to 21.1%. The mean local lordotic angle, which was -5.9° preoperatively, was corrected to 10.5° with surgery and was maintained at 7.7° at the final follow-up. The mean corrective angle was 16.4°, and the mean correction loss was 2.8°. CONCLUSIONS The authors have proposed using minimally invasive, short-segment APCS with OLIF, tailored to the morphology of the collapsed vertebra, to treat LSCS-OVC. APCS achieves neural decompression, reconstruction of anterior support, and correction of local alignment.
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Affiliation(s)
- Kentaro Fukuda
- 1Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama City
| | - Hiroyuki Katoh
- 2Department of Orthopaedic Surgery Surgical Science, Tokai University School of Medicine, Isehara City; and
| | - Yuichiro Takahashi
- 1Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama City
| | - Kazuya Kitamura
- 1Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama City
| | - Daiki Ikeda
- 1Department of Orthopaedic Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama City
- 3Department of Orthopaedic Surgery, Fujita Health University Hospital, Toyoake City, Japan
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14
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Jang HD, Kim EH, Lee JC, Choi SW, Kim K, Shin BJ. Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review. Asian Spine J 2020; 14:898-909. [PMID: 33373513 PMCID: PMC7788360 DOI: 10.31616/asj.2020.0594] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%-35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.
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Affiliation(s)
- Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eung-Ha Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyungbum Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
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15
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Hosogane N, Nojiri K, Suzuki S, Funao H, Okada E, Isogai N, Ueda S, Hikata T, Shiono Y, Watanabe K, Watanabe K, Kaito T, Yamashita T, Fujiwara H, Nagamoto Y, Terai H, Tamai K, Matsuoka Y, Suzuki H, Nishimura H, Tagami A, Yamada S, Adachi S, Ohtori S, Orita S, Furuya T, Yoshii T, Ushio S, Inoue G, Miyagi M, Saito W, Imagama S, Ando K, Sakai D, Nukaga T, Kiyasu K, Kimura A, Inoue H, Nakano A, Harimaya K, Kawaguchi K, Yokoyama N, Oishi H, Doi T, Ikegami S, Shimizu M, Futatsugi T, Kakutani K, Yurube T, Oshima M, Uei H, Aoki Y, Takahata M, Iwata A, Seki S, Murakami H, Yoshioka K, Endo H, Hongo M, Nakanishi K, Abe T, Tsukanishi T, Ishii K. Reply to the Editor: Surgical Treatment of Osteoporotic Vertebral Fracture with Neurological Deficit-A Nationwide Multicenter Study in Japan. Spine Surg Relat Res 2020; 4:292-293. [PMID: 32865540 PMCID: PMC7447343 DOI: 10.22603/ssrr.2020-0033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/04/2020] [Indexed: 01/20/2023] Open
Affiliation(s)
- Naobumi Hosogane
- Department of Orthopedic Surgery, Kyorin University, Tokyo, Japan.,Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kenya Nojiri
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Haruki Funao
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Department of Orthopedic Surgery, International University of Health and Welfare, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Norihiro Isogai
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Department of Orthopedic Surgery, International University of Health and Welfare, Tokyo, Japan
| | - Seiji Ueda
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Hikata
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Shiono
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University, Niigata, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Yamashita
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hiroyasu Fujiwara
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka City University, Osaka, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka City University, Osaka, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Tagami
- Department of Orthopedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Syuta Yamada
- Department of Orthopedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Shinji Adachi
- Department of Orthopedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Chiba University, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Chiba University, Chiba, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuta Ushio
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University, Sagamihara, Japan
| | - Masayuki Miyagi
- Department of Orthopedic Surgery, Kitasato University, Sagamihara, Japan
| | - Wataru Saito
- Department of Orthopedic Surgery, Kitasato University, Sagamihara, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University, Nagoya, Japan
| | - Daisuke Sakai
- Department of Orthopedic Surgery, Tokai University, Isehara, Japan
| | - Tadashi Nukaga
- Department of Orthopedic Surgery, Tokai University, Isehara, Japan
| | - Katsuhito Kiyasu
- Department of Orthopedic Surgery, Kochi University, Nankoku, Japan
| | - Atsushi Kimura
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Hirokazu Inoue
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Katsumi Harimaya
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | | | | | - Hidekazu Oishi
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Toshio Doi
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Shota Ikegami
- Department of Orthopedic Surgery, Shinshu University, Matsumoto, Japan
| | - Masayuki Shimizu
- Department of Orthopedic Surgery, Shinshu University, Matsumoto, Japan
| | | | | | - Takashi Yurube
- Department of Orthopedic Surgery, Kobe University, Kobe, Japan
| | - Masashi Oshima
- Department of Orthopedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Hiroshi Uei
- Department of Orthopedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Yasuchika Aoki
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Masahiko Takahata
- Department of Orthopedic Surgery, Hokkaido University, Sapporo, Japan
| | - Akira Iwata
- Department of Orthopedic Surgery, Hokkaido University, Sapporo, Japan
| | - Shoji Seki
- Department of Orthopedic Surgery, University of Toyama, Toyama, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan
| | | | - Hirooki Endo
- Department of Orthopedic Surgery, Iwate Medical University, Morioka, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University, Akita, Japan
| | | | - Tetsuya Abe
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | | | - Ken Ishii
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Department of Orthopedic Surgery, International University of Health and Welfare, Tokyo, Japan
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16
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Kawabata A, Yoshii T, Hirai T, Ushio S, Kaito T, Yamashita T, Fujiwara H, Nagamoto Y, Matsuoka Y, Suzuki H, Nishimura H, Terai H, Tamai K, Tagami A, Yamada S, Adachi S, Watanabe K, Katsumi K, Ohashi M, Shibuya Y, Harimaya K, Kawaguchi K, Yokoyama N, Oishi H, Doi T, Kimura A, Inoue H, Inoue G, Miyagi M, Saito W, Nakano A, Sakai D, Nukaga T, Ikegami S, Shimizu M, Futatsugi T, Ohtori S, Furuya T, Orita S, Imagama S, Ando K, Kobayashi K, Kiyasu K, Murakami H, Yoshioka K, Seki S, Hongo M, Kakutani K, Yurube T, Aoki Y, Oshima M, Takahata M, Iwata A, Endo H, Abe T, Tsukanishi T, Nakanishi K, Watanabe K, Hikata T, Suzuki S, Isogai N, Okada E, Funao H, Ueda S, Shiono Y, Nojiri K, Hosogane N, Ishii K. Effect of bisphosphonates or teriparatide on mechanical complications after posterior instrumented fusion for osteoporotic vertebral fracture: a multi-center retrospective study. BMC Musculoskelet Disord 2020; 21:420. [PMID: 32611386 PMCID: PMC7331246 DOI: 10.1186/s12891-020-03452-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 06/23/2020] [Indexed: 12/18/2022] Open
Abstract
Background The optimal treatment of osteoporosis after reconstruction surgery for osteoporotic vertebral fractures (OVF) remains unclear. In this multicentre retrospective study, we investigated the effects of typically used agents for osteoporosis, namely, bisphosphonates (BP) and teriparatide (TP), on surgical results in patients with osteoporotic vertebral fractures. Methods Retrospectively registered data were collected from 27 universities and affiliated hospitals in Japan. We compared the effects of BP vs TP on postoperative mechanical complication rates, implant-related reoperation rates, and clinical outcomes in patients who underwent posterior instrumented fusion for OVF. Data were analysed according to whether the osteoporosis was primary or glucocorticoid-induced. Results A total of 159 patients who underwent posterior instrumented fusion for OVF were included. The overall mechanical complication rate was significantly lower in the TP group than in the BP group (BP vs TP: 73.1% vs 58.2%, p = 0.045). The screw backout rate was significantly lower and the rates of new vertebral fractures and pseudoarthrosis tended to be lower in the TP group than in the BP group. However, there were no significant differences in lumbar functional scores and visual analogue scale pain scores or in implant-related reoperation rates between the two groups. The incidence of pseudoarthrosis was significantly higher in patients with glucocorticoid-induced osteoporosis (GIOP) than in those with primary osteoporosis; however, the pseudoarthrosis rate was reduced by using TP. The use of TP also tended to reduce the overall mechanical complication rate in both primary osteoporosis and GIOP. Conclusions The overall mechanical complication rate was lower in patients who received TP than in those who received a BP postoperatively, regardless of type of osteoporosis. The incidence of pseudoarthrosis was significantly higher in patients with GIOP, but the use of TP reduced the rate of pseudoarthrosis in GIOP patients. The use of TP was effective to reduce postoperative complications for OVF patients treated with posterior fusion.
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Affiliation(s)
- Atsuyuki Kawabata
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Toshitaka Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan. .,Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1 Chome-5-45 Yushima, Bunkyo City, Tokyo, 113-8510, Japan.
| | - Takashi Hirai
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Shuta Ushio
- Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Takashi Kaito
- Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Tomoya Yamashita
- Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Hiroyasu Fujiwara
- Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yukitaka Nagamoto
- Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Yuji Matsuoka
- Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Hidekazu Suzuki
- Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Hirosuke Nishimura
- Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Hidetomi Terai
- Department of Orthopaedic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Koji Tamai
- Department of Orthopaedic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan
| | - Atsushi Tagami
- Department of Orthopaedic Surgery, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Syuta Yamada
- Department of Orthopaedic Surgery, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Shinji Adachi
- Department of Orthopaedic Surgery, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Keiichi Katsumi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Masayuki Ohashi
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Yohei Shibuya
- Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan
| | - Katsumi Harimaya
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Kenichi Kawaguchi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Nobuhiko Yokoyama
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Hidekazu Oishi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Toshiro Doi
- Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan
| | - Atsushi Kimura
- Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
| | - Hirokazu Inoue
- Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan
| | - Gen Inoue
- Department of Orthopaedic Surgery, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Masayuki Miyagi
- Department of Orthopaedic Surgery, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Wataru Saito
- Department of Orthopaedic Surgery, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa, 252-0374, Japan
| | - Atsushi Nakano
- Department of Orthopaedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki City, Osaka, 569-0801, Japan
| | - Daisuke Sakai
- Department of Orthopaedic Surgery, Tokai University, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Tadashi Nukaga
- Department of Orthopaedic Surgery, Tokai University, 143 Shimokasuya, Isehara City, Kanagawa, 259-1193, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University, 3-1-1, Asahi, Matsumoto City, Nagano, 390-8621, Japan
| | - Masayuki Shimizu
- Department of Orthopaedic Surgery, Shinshu University, 3-1-1, Asahi, Matsumoto City, Nagano, 390-8621, Japan
| | - Toshimasa Futatsugi
- Department of Orthopaedic Surgery, Shinshu University, 3-1-1, Asahi, Matsumoto City, Nagano, 390-8621, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan
| | - Takeo Furuya
- Department of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan
| | - Sumihisa Orita
- Department of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8670, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, 466-8560, Japan
| | - Kei Ando
- Department of Orthopaedic Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, 466-8560, Japan
| | - Kazuyoshi Kobayashi
- Department of Orthopaedic Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, 466-8560, Japan
| | - Katsuhito Kiyasu
- Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku City, Kochi, 783-8505, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa City, Ishikawa, 920-8641, Japan
| | - Katsuhito Yoshioka
- Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa City, Ishikawa, 920-8641, Japan
| | - Shoji Seki
- Department of Orthopaedic Surgery, University of Toyama, 2630 Sugitani, Toyama City, Toyama, 930-0194, Japan
| | - Michio Hongo
- Department of Orthopaedic Surgery, Akita University, 1-1-1 Hondo, Akita City, Akita, 010-8543, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe City, Hyogo, 650-0017, Japan
| | - Yasuchika Aoki
- Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane City, Chiba, 283-8686, Japan
| | - Masashi Oshima
- Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University, North-15, West-7, Kita-ku, Sapporo City, Hokkaido, 060-8638, Japan
| | - Akira Iwata
- Department of Orthopaedic Surgery, Hokkaido University, North-15, West-7, Kita-ku, Sapporo City, Hokkaido, 060-8638, Japan
| | - Hirooki Endo
- Department of Orthopaedic Surgery, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Shiwa-gun, Iwate, 028-3694, Japan
| | - Tetsuya Abe
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City, Ibaraki, 305-8577, Japan
| | - Toshinori Tsukanishi
- Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City, Ibaraki, 305-8577, Japan
| | - Kazuyoshi Nakanishi
- Department of Orthopaedic Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, Hiroshima, 734-8551, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomohiro Hikata
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Norihiro Isogai
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Eijiro Okada
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Mita, Minato-ku, Tokyo, 108-8329, Japan
| | - Seiji Ueda
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuta Shiono
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kenya Nojiri
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naobumi Hosogane
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama, 359-8513, Japan
| | - Ken Ishii
- Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Mita, Minato-ku, Tokyo, 108-8329, Japan
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17
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Schwartz R, Urits I, D Kaye A, Viswanath O. Surgical Treatment of Osteoporotic Vertebral Fracture with Neurological Deficit-A Nationwide Study in Japan -A Pain Physician's Perspective. Spine Surg Relat Res 2020; 4:290-291. [PMID: 32864501 PMCID: PMC7447334 DOI: 10.22603/ssrr.2020-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 02/07/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Ruben Schwartz
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants-Envision Physician Consultants, Phoenix, Arizona, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
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18
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Isogai N, Hosogane N, Funao H, Nojiri K, Suzuki S, Okada E, Ueda S, Hikata T, Shiono Y, Watanabe K, Watanabe K, Kaito T, Yamashita T, Fujiwara H, Nagamoto Y, Terai H, Tamai K, Matsuoka Y, Suzuki H, Nishimura H, Tagami A, Yamada S, Adachi S, Ohtori S, Orita S, Furuya T, Yoshii T, Ushio S, Inoue G, Miyagi M, Saito W, Imagama S, Ando K, Sakai D, Nukaga T, Kiyasu K, Kimura A, Inoue H, Nakano A, Harimaya K, Kawaguchi K, Yokoyama N, Oishi H, Doi T, Ikegami S, Shimizu M, Futatsugi T, Kakutani K, Yurube T, Oshima M, Uei H, Aoki Y, Takahata M, Iwata A, Seki S, Murakami H, Yoshioka K, Endo H, Hongo M, Nakanishi K, Abe T, Tsukanishi T, Ishii K. The Surgical Outcomes of Spinal Fusion for Osteoporotic Vertebral Fractures in the Lower Lumbar Spine with a Neurological Deficit. Spine Surg Relat Res 2020; 4:199-207. [PMID: 32864485 PMCID: PMC7447347 DOI: 10.22603/ssrr.2019-0079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/07/2019] [Indexed: 12/27/2022] Open
Abstract
Introduction Osteoporotic vertebral fracture (OVF) is the most common osteoporotic fracture, and some patients require surgical intervention to improve their impaired activities of daily living with neurological deficits. However, many previous reports have focused on OVF around the thoracolumbar junction, and the surgical outcomes of lumbar OVF have not been thoroughly discussed. We aimed to investigate the surgical outcomes for lumbar OVF with a neurological deficit. Methods Patients who underwent fusion surgery for thoracolumbar OVF with a neurological deficit were enrolled at 28 institutions. Clinical information, comorbidities, perioperative complications, Japanese Orthopaedic Association scores, visual analog scale scores, and radiographic parameters were compared between patients with lower lumbar fracture (L3-5) and those with thoracolumbar junction fracture (T10-L2). Each patient with lower lumbar fracture (L group) was matched with to patients with thoracolumbar junction fracture (T group). Results A total 403 patients (89 males and 314 females, mean age: 73.8 ± 7.8 years, mean follow-up: 3.9 ± 1.7 years) were included in this study. Lower lumbar OVF was frequently found in patients with lower bone mineral density. After matching, mechanical failure was more frequent in the L group (L group: 64%, T group: 39%; p < 0.001). There was no difference between groups in the clinical and radiographical outcomes, although the rates of complication and revision surgery were still high in both groups. Conclusions The surgical intervention for OVF is effective in patients with myelopathy or radiculopathy regardless of the surgical level, although further study is required to improve clinical and radiographical outcomes. Level of evidence Level III
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Affiliation(s)
- Norihiro Isogai
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan.,Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naobumi Hosogane
- Department of Orthopedic Surgery, Kyorin University, Tokyo, Japan
| | - Haruki Funao
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan.,Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kenya Nojiri
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Eijiro Okada
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Ueda
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Hikata
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yuta Shiono
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kei Watanabe
- Department of Orthopedic Surgery, Niigata University, Niigata, Japan
| | - Takashi Kaito
- Department of Orthopedic Surgery, Osaka University, Suita, Japan
| | - Tomoya Yamashita
- Department of Orthopedic Surgery, Osaka University, Suita, Japan
| | | | | | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka City University, Osaka, Japan
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka City University, Osaka, Japan
| | - Yuji Matsuoka
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hidekazu Suzuki
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Tokyo, Japan
| | - Atsushi Tagami
- Department of Orthopedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Shuta Yamada
- Department of Orthopedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Shinji Adachi
- Department of Orthopedic Surgery, Nagasaki University, Nagasaki, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Chiba University, Chiba, Japan
| | - Takeo Furuya
- Department of Orthopedic Surgery, Chiba University, Chiba, Japan
| | - Toshitaka Yoshii
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuta Ushio
- Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Gen Inoue
- Department of Orthopedic Surgery, Kitasato University, Sagamihara, Japan
| | - Masayuki Miyagi
- Department of Orthopedic Surgery, Kitasato University, Sagamihara, Japan
| | - Wataru Saito
- Department of Orthopedic Surgery, Kitasato University, Sagamihara, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University, Nagoya, Japan
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University, Nagoya, Japan
| | - Daisuke Sakai
- Department of Orthopedic Surgery, Tokai University, Isehara, Japan
| | - Tadashi Nukaga
- Department of Orthopedic Surgery, Tokai University, Isehara, Japan
| | - Katsuhito Kiyasu
- Department of Orthopedic Surgery, Kochi University, Nankoku, Japan
| | - Atsushi Kimura
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Hirokazu Inoue
- Department of Orthopedic Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Nakano
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Katsumi Harimaya
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | | | | | - Hidekazu Oishi
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Toshiro Doi
- Department of Orthopedic Surgery, Kyushu University, Fukuoka, Japan
| | - Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Japan
| | - Masayuki Shimizu
- Department of Orthopaedic Surgery, Shinshu University, Matsumoto, Japan
| | | | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masashi Oshima
- Department of Orthopedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Hiroshi Uei
- Department of Orthopedic Surgery, Nihon University Itabashi Hospital, Tokyo, Japan
| | - Yasuchika Aoki
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, Togane, Japan
| | - Masahiko Takahata
- Department of Orthopedic Surgery, Hokkaido University, Sapporo, Japan
| | - Akira Iwata
- Department of Orthopedic Surgery, Hokkaido University, Sapporo, Japan
| | - Shoji Seki
- Department of Orthopedic Surgery, University of Toyama, Toyama, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Kanazawa University, Kanazawa, Japan
| | | | - Hirooki Endo
- Department of Orthopedic Surgery, Iwate Medical University, Morioka, Japan
| | - Michio Hongo
- Department of Orthopedic Surgery, Akita University, Akita, Japan
| | | | - Tetsuya Abe
- Department of Orthopedic Surgery, University of Tsukuba, Tsukuba, Japan
| | | | - Ken Ishii
- Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare (IUHW), Narita, Japan.,Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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