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Sawada Y, Takahashi S, Terai H, Kato M, Toyoda H, Suzuki A, Tamai K, Yabu A, Iwamae M, Nakamura H. Short-Term Risk Factors for Distal Junctional Kyphosis after Spinal Reconstruction Surgery in Patients with Osteoporotic Vertebrae. Asian Spine J 2024; 18:101-109. [PMID: 38379382 PMCID: PMC10910134 DOI: 10.31616/asj.2023.0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/01/2023] [Accepted: 10/30/2023] [Indexed: 02/22/2024] Open
Abstract
STUDY DESIGN Level 3 retrospective cohort case-control study. PURPOSE This study aimed to investigate the risk factors for distal junctional kyphosis (DJK) caused by osteoporotic vertebral fractures following spinal reconstruction surgery, with a focus on the sagittal stable vertebra. OVERVIEW OF LITERATURE Despite the rarity of reports on DJK in this setting, DJK was reported to reduce when the lower instrumented vertebra (LIV) was extended to the sagittal stable vertebra in the posterior corrective fixation for Scheuermann's disease. METHODS This study included 46 patients who underwent spinal reconstruction surgery for thoracolumbar osteoporotic vertebral fractures and kyphosis and were followed up for 1 year postoperatively. DJK was defined as an advanced kyphosis angle >10° between the LIV and one lower vertebra. The patients were divided into groups with and without DJK. The risk factors of the two groups, such as patient background, surgery-related factors, radiographic parameters, and clinical outcomes, were analyzed. RESULTS The DJK and non-DJK groups included 14 and 32 patients, respectively, without significant differences in patient background. Those with instability in the distal adjacent LIV disc had a significantly higher risk of DJK occurrence (28.6% vs. 3.2%, p=0.027). DJK occurrence significantly increased in those with the sagittal stable vertebra not included in the fixation range (57.1% vs. 18.8%, p=0.020). Other preoperative radiographic parameters were not significantly different. Instability in the distal adjacent LIV disc (adjusted odds ratio, 14.50; p=0.029) and the exclusion of the sagittal stable vertebra from the fixation range (adjusted odds ratio, 5.29; p=0.020) were significant risk factors for DJK occurrence. CONCLUSIONS Regarding spinal reconstruction surgery in patients with osteoporotic vertebral fractures, instability in the distal adjacent LIV disc and the exclusion of the sagittal stable vertebra from the fixation range were risk factors for DJK occurrence in the short term.
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Affiliation(s)
- Yuta Sawada
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Shinji Takahashi
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hidetomi Terai
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Minori Kato
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akinobu Suzuki
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Koji Tamai
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Akito Yabu
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Masayoshi Iwamae
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedics, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Iwata S, Kotani T, Sakuma T, Iijima Y, Okuwaki S, Ohyama S, Maki S, Eguchi Y, Orita S, Inage K, Shiga Y, Inoue M, Akazawa T, Minami S, Ohtori S. Risk Factors for Cage Subsidence in Minimally Invasive Lateral Corpectomy for Osteoporotic Vertebral Fractures. Spine Surg Relat Res 2023; 7:356-362. [PMID: 37636151 PMCID: PMC10447195 DOI: 10.22603/ssrr.2022-0215] [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: 10/28/2022] [Accepted: 12/15/2022] [Indexed: 08/29/2023] Open
Abstract
Introduction This study aims to investigate risk factors for cage subsidence following minimally invasive lateral corpectomy for osteoporotic vertebral fractures. Methods Eight males and 13 females (77.2±6.0 years old) with osteoporotic vertebral fractures who underwent single corpectomy using a wide-footprint expandable cage with at least a 1-year follow-up were retrospectively included. The endplate cage (EC) angle was defined as the angle between the vertebral body's endplate and the cage's base on the cranial and caudal sides. A sagittal computed tomography scan was performed immediately after surgery and at the final follow-up, with cage subsidence defined as subsidence of ≥2 mm on the cranial or caudal side. Risk factors were analyzed by dividing cases into groups with (n=6) and without (n=15) cage subsidence. Results No significant differences were noted in age, bone mineral density, number of fixed vertebrae, sagittal parameters, preoperative and final kyphosis angle, amount of kyphosis angle correction, bone union, screw loosening, and number of other vertebral fractures preoperatively and 1-year postoperatively between the two groups. No difference was noted in cranial EC angle, but a significant difference was noted in caudal EC angle in the group with (10.7±4.1°) and without (4.7±4.2°) subsidence (P=0.008). Logistic regression analysis with the dependent variable as presence or absence of subsidence showed that caudal EC angle (>7.5°) was a significant factor (odds ratio: 20, 95% confidence interval: 1.655-241.7, P=0.018). Conclusions In minimally invasive lateral corpectomy for osteoporotic vertebral fractures, a cage tilted more than 7.5° to the caudal vertebral endplate is a risk factor for cage subsidence. The cage should be placed as perpendicular to the endplate as possible, especially to the caudal vertebral body, to avoid cage subsidence.
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Affiliation(s)
- Shuhei Iwata
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Toshiaki Kotani
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Tsuyoshi Sakuma
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Yasushi Iijima
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shun Okuwaki
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Shuhei Ohyama
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Satoshi Maki
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yawara Eguchi
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Sumihisa Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kazuhide Inage
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasuhiro Shiga
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Inoue
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Tsutomu Akazawa
- Department of Orthopedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shohei Minami
- Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan
| | - Seiji Ohtori
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
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Inoue T, Inokuchi A, Izumi T, Imamura R, Hamada T, Nakamura K, Ebihara T, Inoue H, Kuroki Y, Arizono T. Co-existence of Lumbar Disc Herniation and Posterior Ring Apophyseal Fracture: It Is Not Rare and Computed Tomography Is Useful. Cureus 2023; 15:e35475. [PMID: 36999108 PMCID: PMC10043829 DOI: 10.7759/cureus.35475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2023] [Indexed: 02/27/2023] Open
Abstract
Introduction Posterior ring apophyseal fracture (PRAF) is characterized by the separation of bone fragments and sometimes coexists with lumbar disc herniation (LDH). However, how often these conditions coexist and the details of the clinical course remain unclear. Methods We analyzed 200 patients who underwent surgical treatment for LDH at our hospital from January 2016 to December 2020. Among these, we reviewed 21 patients who underwent microendoscopic surgery to treat PRAF. They consisted of 11 male and 10 female patients, ranging in age from 15 to 63 years. The average age was 32.8 months, and the average follow-up period was 39.8 years. We performed simple roentgenography and magnetic resonance imaging for all patients and computed tomography for about 80% of the patients. We evaluated the type of PRAF fragment (Takata classification), disease level, Japanese Orthopedic Association (JOA) score, Roland-Morris Disability Questionnaire (RDQ) score, operating time, intraoperative blood loss, and perioperative complications. Results A total of 10.5% of patients with LDH also had PRAF. The mean JOA score significantly improved from 10.6 ± 5.7 points before surgery to 21.4 ± 5.1 points at the final observation (p < 0.05). The mean RDQ score significantly improved from 17.1 ± 4.5 preoperatively to 5.5 ± 0.5 at the final observation (p < 0.05). The average operation time was 88.6 minutes. There were no complications requiring early surgery that were due to postoperative infection or epidural hematoma, but one patient required reoperation. Conclusion This study showed that PRAF coexisted with LDH in about 10% of cases, and the outcomes of surgical treatment were generally good. Computed tomography is recommended to improve the diagnostic rate and assist with surgical planning and intraoperative decision-making.
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Innovation of Surgical Techniques for Screw Fixation in Patients with Osteoporotic Spine. J Clin Med 2022; 11:jcm11092577. [PMID: 35566703 PMCID: PMC9101243 DOI: 10.3390/jcm11092577] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 02/04/2023] Open
Abstract
Osteoporosis is a common disease in elderly populations and is a major public health problem worldwide. It is not uncommon for spine surgeons to perform spinal instrumented fusion surgeries for osteoporotic patients. However, in patients with severe osteoporosis, instrumented fusion may result in screw loosening, implant failure or nonunion because of a poor bone quality and decreased pedicle screw stability as well as increased graft subsidence risk. In addition, revision surgeries to correct failed instrumentation are becoming increasingly common in patients with osteoporosis. Therefore, techniques to enhance the fixation of pedicle screws are required in spinal surgeries for osteoporotic patients. To date, various instrumentation methods, such as a supplemental hook, sublaminar taping and sacral alar iliac screws, and modified screwing techniques have been available for reinforcing pedicle screw fixation. In addition, several materials, including polymethylmethacrylate and hydroxyapatite stick/granules, for insertion into prepared screw holes, can be used to enhance screw fixation. Many biomechanical tests support the effectiveness of these augmentation methods. We herein review the current therapeutic strategies for screw fixation and augmentation methods in the surgical treatment of patients with an osteoporotic spine.
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Okuwaki S, Tatsumura M, Eto F, Funayama T, Yamazaki M. Usefulness of the Round Endcap Expandable Cage Placed on the Vertebral Ring Apophysis in Anterior Spinal Reconstruction. Cureus 2022; 14:e23586. [PMID: 35494910 PMCID: PMC9045845 DOI: 10.7759/cureus.23586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 11/05/2022] Open
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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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Segi N, Nakashima H, Kanemura T, Satake K, Ito K, Tsushima M, Tanaka S, Ando K, Machino M, Ito S, Yamaguchi H, Koshimizu H, Tomita H, Ouchida J, Morita Y, Imagama S. Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture. J Clin Med 2021; 10:5664. [PMID: 34884365 PMCID: PMC8658075 DOI: 10.3390/jcm10235664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of the current study was to compare outcomes between lateral access vertebral reconstruction (LAVR) using a rectangular footplate cage and the conventional procedure using a cylindrical footplate cage in patients with osteoporotic vertebral fracture (OVF). We included 46 patients who underwent anterior-posterior combined surgery for OVF: 24 patients underwent LAVR (Group L) and 22 underwent the conventional procedure (Group C). Preoperative, postoperative, and 1- and 2-year follow-up X-ray images were used to measure local lordotic angle, correction loss, and cage subsidence (>2 mm in vertebral endplate depression). In anterior surgery, the operation time was significantly shorter (183 vs. 248 min, p < 0.001) and the blood loss was significantly less (148 vs. 406 mL, p = 0.01) in Group L than in Group C. In Group C, two patients had anterior instrumentation failure. Correction loss was significantly smaller in Group L than in Group C (1.9° vs. 4.9° at 1 year, p = 0.02; 2.5° vs. 6.5° at 2 years, p = 0.04, respectively). Cage subsidence was significantly less in Group L than in Group C (29% vs. 80%, p < 0.001). LAVR using a rectangular footplate cage is an effective treatment for OVF to minimize surgical invasiveness and postoperative correction loss.
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Affiliation(s)
- Naoki Segi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Hiroaki Nakashima
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Tokumi Kanemura
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Kotaro Satake
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Kenyu Ito
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Mikito Tsushima
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Satoshi Tanaka
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Kei Ando
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Masaaki Machino
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Sadayuki Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Hidetoshi Yamaguchi
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Hiroyuki Koshimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Hiroyuki Tomita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Jun Ouchida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
- Department of Orthopedic Surgery, Konan Kosei Hospital, 137 Takayamachi Omatsubara, Konan 483-8704, Japan; (T.K.); (K.S.); (K.I.); (M.T.); (S.T.)
| | - Yoshinori Morita
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya 466-8560, Japan; (N.S.); (K.A.); (M.M.); (S.I.); (H.Y.); (H.K.); (H.T.); (J.O.); (Y.M.); (S.I.)
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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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