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01-05-2019 | Original Article

Hybrid stabilization of unstable osteoporotic thoracolumbar vertebral body fractures: clinical and radiological outcome after a mean of 4 years

Authors: Ulrich J. Spiegl, Christine Anemüller, Jan-Sven Jarvers, Nicolaus von der Höh, Christoph Josten, Christoph-Eckhard Heyde

Published in: European Spine Journal | Issue 5/2019

Abstract

Purpose

The aim of this study was to evaluate midterm results after hybrid stabilization of unstable osteoporotic fractures of the thoracolumbar junction.

Methods

This retrospective study was performed at a level I trauma center. A total of 113 patients aged 61 and older were stabilized using hybrid stabilization consisting of short-segmental posterior instrumentation and augmentation of the fractured vertebral body after suffering an unstable osteoporotic vertebral body fracture at the thoracolumbar spine. All patients were treated by hybrid stabilization. The primary outcome parameters were the ODI score and loss of reduction. Secondary radiological outcome parameters were the sagittal alignment parameters.

Results

Seventy-two women and 41 men (74.6 ± 6.8 years) were included. Sixty-nine patients (61%) were re-evaluated after a mean of 48 months. Seventeen patients have died during the follow-up period (15%). A total of five in-patient complications were documented (4.4%). Additionally, 12 patients (17.4%) suffered from further osteoporotic vertebral body fractures affecting vertebral bodies of different levels. The average ODI score at the final follow-up was 29.9 (± 22.0). Thereby, 66.6% of all patients had low to moderate limitations. The average regional sagittal loss of reduction was 7.4% (± 5.6%). Loss of reduction was below 10° in 78% of the patients. There were statistically significant correlations between the loss of reduction and the ODI score, pelvic incidence and latest Cobb angle, and between the ODI scores and the lumbar lordosis.

Conclusions

The majority of patients had low or moderate limitations and low to moderate reduction loss. Thereby, high loss of reduction correlated directly with inferior outcomes.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.

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Abdelgawaad AS, Ezzati A, Govindasamy R, Krajnovic B, Elnady B, Said GZ (2017) Kyphoplasty for osteoporotic vertebral fractures with posterior wall injury. Spine J. https://doi.org/10.1016/j.spinee.2017.11.001 CrossRefPubMed

Aubry-Rozier B, Stoll D, Gonzalez Rodriguez E, Hans D, Prudent V, Seuret A, Farron A, Lamy O (2018) Impact of a fracture liaison service on patient management after an osteoporotic fracture: the CHUV FLS. Swiss Med Wkly 148:w14579. https://doi.org/10.4414/smw.2018.14579 CrossRefPubMed

Bae H, Shen M, Maurer P, Peppelman W, Beutler W, Linovitz R, Westerlund E, Peppers T, Lieberman I, Kim C, Girardi F (2010) Clinical experience using Cortoss for treating vertebral compression fractures with vertebroplasty and kyphoplasty: twenty four-month follow-up. Spine (Phila Pa 1976) 35(20):E1030–E1036. https://doi.org/10.1097/BRS.0b013e3181dcda75 CrossRef

Buchbinder R, Johnston RV, Rischin KJ, Homik J, Jones CA, Golmohammadi K, Kallmes DF (2018) Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev 4:CD006349. https://doi.org/10.1002/14651858.CD006349.pub3 CrossRefPubMed

Che H, Breuil V, Cortet B, Paccou J, Thomas T, Chapuis L, Debiais F, Mehsen-Cetre N, Javier RM, Loiseau Peres S, Roux C, Briot K (2018) Vertebral fractures cascade: potential causes and risk factors. Osteoporos Int. https://doi.org/10.1007/s00198-018-4793-1 CrossRefPubMed

Eschler A, Ender SA, Schiml K, Mittlmeier T, Gradl G (2015) Bony healing of unstable thoracolumbar burst fractures in the elderly using percutaneously applied titanium mesh cages and a transpedicular fixation system with expandable screws. PLoS ONE 10(2):e0117122. https://doi.org/10.1371/journal.pone.0117122 CrossRefPubMedPubMedCentral

Fuentes S, Blondel B, Metellus P, Gaudart J, Adetchessi T, Dufour H (2010) Percutaneous kyphoplasty and pedicle screw fixation for the management of thoraco-lumbar burst fractures. Eur Spine J 19(8):1281–1287. https://doi.org/10.1007/s00586-010-1444-4 CrossRefPubMedPubMedCentral

Josten C, Schmidt C, Spiegl U (2012) Osteoporotic vertebral body fractures of the thoracolumbar spine: diagnostics and therapeutic strategies. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 83(10):866–874. https://doi.org/10.1007/s00104-012-2338-2 CrossRefPubMed

Kim HJ, Park S, Park SH, Park J, Chang BS, Lee CK, Yeom JS (2018) Prevalence of frailty in patients with osteoporotic vertebral compression fracture and its association with numbers of fractures. Yonsei Med J 59(2):317–324. https://doi.org/10.3349/ymj.2018.59.2.317 CrossRefPubMed

10.

Kobayashi K, Ando K, Nishida Y, Ishiguro N, Imagama S (2018) Epidemiological trends in spine surgery over 10 years in a multicenter database. Eur Spine J 27(8):1698–1703. https://doi.org/10.1007/s00586-018-5513-4 CrossRefPubMed

11.

Korovessis P, Mpountogianni E, Syrimpeis V (2016) Percutaneous pedicle screw fixation plus kyphoplasty for thoracolumbar fractures A2, A3 and B2. Eur Spine J. https://doi.org/10.1007/s00586-016-4743-6 CrossRefPubMed

12.

Li Q, Sun J, Cui X, Jiang Z, Li T (2017) Analysis of correlation between degeneration of lower lumbar paraspinal muscles and spinopelvic alignment in patients with osteoporotic vertebral compression fracture. J Back Musculoskelet Rehabil 30(6):1209–1214. https://doi.org/10.3233/BMR-150506 CrossRefPubMed

13.

Li X, Lu Y, Lin X (2017) Refracture of osteoporotic vertebral body after treatment by balloon kyphoplasty: three cases report. Medicine 96(49):e8961. https://doi.org/10.1097/MD.0000000000008961 CrossRefPubMedPubMedCentral

14.

Li YX, Guo DQ, Zhang SC, Liang Yuan K, Mo GY, Li DX, Guo HZ, Tang Y, Luo PJ (2018) Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Int Orthop. https://doi.org/10.1007/s00264-018-3838-6 CrossRefPubMedPubMedCentral

15.

Newman M, Minns Lowe C, Barker K (2016) Spinal orthoses for vertebral osteoporosis and osteoporotic vertebral fracture: a systematic review. Arch Phys Med Rehabil 97(6):1013–1025. https://doi.org/10.1016/j.apmr.2015.10.108 CrossRefPubMed

16.

Rahamimov N, Mulla H, Shani A, Freiman S (2012) Percutaneous augmented instrumentation of unstable thoracolumbar burst fractures. Eur Spine J 21(5):850–854. https://doi.org/10.1007/s00586-011-2106-x CrossRefPubMed

17.

Riesner HJ, Kiupel K, Lang P, Stuby F, Friemert B, Palm HG (2016) Clinical relevance of cement leakage after radiofrequency Kyphoplasty vs. balloon Kyphoplasty: a prospective randomised study. Zeitschrift fur Orthopadie und Unfallchirurgie 154(4):370–376. https://doi.org/10.1055/s-0042-104069 CrossRefPubMed

18.

Schnake KJ, Blattert TR, Hahn P, Franck A, Hartmann F, Ullrich B, Verheyden A, Mörk S, Zimmermann V, Gonschorek O, Müller M, Katscher S, Saman AE, Pajenda G, Morrison R, Schinkel C, Piltz S, Partenheimer A, Müller CW, Gercek E, Scherer M, Bouzraki N, Kandziora F, Spine Section of the German Society for Orthopaedics and Trauma (2018) Classification of osteoporotic thoracolumbar spine fractures: recommendations of the spine section of the German society for orthopaedics and trauma (DGOU). Global Spine J 8(2 Suppl):46S–49S. https://doi.org/10.1177/2192568217717972 CrossRefPubMedPubMedCentral

19.

Spiegl U, Jarvers JS, Heyde CE, Josten C (2017) Osteoporotic vertebral body fractures of the thoracolumbar spine: indications and techniques of a 360 degrees -stabilization. Eur J Trauma Emerg Surg 43(1):27–33. https://doi.org/10.1007/s00068-016-0751-9 CrossRefPubMed

20.

Spiegl UJ, Hauck S, Merkel P, Buhren V, Gonschorek O (2012) Long-term results of kyphoplasty with additive dorsal instrumentation of incomplete burst fractures of the thoracolumbar spine in the elderly. Zeitschrift fur Orthopadie und Unfallchirurgie 150(6):579–582. https://doi.org/10.1055/s-0032-1327936 CrossRefPubMed

21.

Sun ZY, Li XF, Zhao H, Lin J, Qian ZL, Zhang ZM, Yang HL (2017) Percutaneous balloon Kyphoplasty in treatment of painful osteoporotic occult vertebral fracture: a retrospective study of 89 cases. Med Sci Monit Res 23:1682–1690CrossRef

22.

Svedbom A, Borgstom F, Hernlund E, Strom O, Alekna V, Bianchi ML, Clark P, Curiel MD, Dimai HP, Jurisson M, Kallikorm R, Lember M, Lesnyak O, McCloskey E, Sanders KM, Silverman S, Solodovnikov A, Tamulaitiene M, Thomas T, Toroptsova N, Uuskula A, Tosteson ANA, Jonsson B, Kanis JA (2018) Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures-results from the ICUROS. Osteoporos Int 29(3):557–566. https://doi.org/10.1007/s00198-017-4317-4 CrossRefPubMed

23.

Uchida K, Nakajima H, Yayama T, Miyazaki T, Hirai T, Kobayashi S, Chen K, Guerrero AR, Baba H (2010) Vertebroplasty-augmented short-segment posterior fixation of osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine: comparisons with posterior surgery without vertebroplasty and anterior surgery. J Neurosurg Spine 13(5):612–621. https://doi.org/10.3171/2010.5.SPINE09813 CrossRefPubMed

24.

Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, Reinhold M, Aarabi B, Kandziora F, Chapman J, Shanmuganathan R, Fehlings M, Vialle L, Injury AOSC, Trauma Knowledge F (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 38(23):2028–2037. https://doi.org/10.1097/BRS.0b013e3182a8a381 CrossRef

25.

Verlaan JJ, Somers I, Dhert WJ, Oner FC (2015) Clinical and radiological results 6 years after treatment of traumatic thoracolumbar burst fractures with pedicle screw instrumentation and balloon assisted endplate reduction. Spine J 15(6):1172–1178. https://doi.org/10.1016/j.spinee.2013.11.044 CrossRefPubMed

26.

Yasuda T, Kawaguchi Y, Suzuki K, Nakano M, Seki S, Watabnabe K, Kanamori M, Kimura T (2017) Five-year follow up results of posterior decompression and fixation surgery for delayed neural disorder associated with osteoporotic vertebral fracture. Medicine 96(51):e9395. https://doi.org/10.1097/MD.0000000000009395 CrossRefPubMedPubMedCentral

27.

Zhao WT, Qin DP, Zhang XG, Wang ZP, Tong Z (2018) Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture: a three-dimensional finite element analysis. J Orthop Surg Res 13(1):32. https://doi.org/10.1186/s13018-018-0733-1 CrossRefPubMedPubMedCentral

Title: Hybrid stabilization of unstable osteoporotic thoracolumbar vertebral body fractures: clinical and radiological outcome after a mean of 4 years
Authors: Ulrich J. Spiegl
Christine Anemüller
Jan-Sven Jarvers
Nicolaus von der Höh
Christoph Josten
Christoph-Eckhard Heyde
Publication date: 01-05-2019
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 5/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-05957-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Hybrid stabilization of unstable osteoporotic thoracolumbar vertebral body fractures: clinical and radiological outcome after a mean of 4 years

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Graphical abstract

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