Skip to main content
Top
Published in: International Orthopaedics 11/2016

01-11-2016 | Original Paper

Surgical treatment for osteoporotic thoracolumbar vertebral collapse using vertebroplasty with posterior spinal fusion: a prospective multicenter study

Authors: Keiichi Katsumi, Toru Hirano, Kei Watanabe, Masayuki Ohashi, Akiyoshi Yamazaki, Takui Ito, Kimihiko Sawakami, Atsuki Sano, Ren Kikuchi, Naoto Endo

Published in: International Orthopaedics | Issue 11/2016

Login to get access

Abstract

Purpose

The study aimed to investigate the clinical outcomes and limitations after vertebroplasty with posterior spinal fusion (VP+PSF) without neural decompression for osteoporotic vertebral collapse.

Methods

We conducted a prospective multicenter study including 45 patients (12 men and 33 women, mean age: 77.0 years) evaluated between 2008 and 2012. Operation time, blood loss, visual analog scale (VAS) of back pain, neurological status, kyphosis angle in the fused area, and vertebral union of the collapsed vertebra were evaluated.

Results

The mean operation time was 162 min and blood loss was 381 mL. The postoperative VAS score significantly improved, and the neurological status improved in 35 patients (83 %), and none of the remaining patients demonstrated a deteriorating neurological status at two years post-operatively. The mean kyphosis angle pre-operatively, immediately post-operatively, and two years post-operatively was 23.8°, 10.7°, and 24.3°, respectively, and there was no significant difference between the angles pre-operatively and two years post-operatively. The extensive correction of kyphosis >16° was a risk factor for a higher correction loss and subsequent fracture. Union of the collapsed vertebra was observed in 43 patients (95 %) at two years post-operatively.

Conclusions

The present study suggests that spinal stabilization rather than neural decompression is essential to treat OVC. Short-segment VP+PSF can achieve a high union rate of collapsed vertebra and provide a significant improvement in back pain or neurological status with less invasive surgery, but has a limit of kyphosis correction more than 16°.
Literature
1.
go back to reference Frost HM (1981) Clinical management of the symptomatic osteoporotic patient. Orthop Clin North Am 12:671–681PubMed Frost HM (1981) Clinical management of the symptomatic osteoporotic patient. Orthop Clin North Am 12:671–681PubMed
2.
go back to reference Lee YL, Yip KM (1996) The osteoporotic spine. Clin Orthop Relat Res 323:91–97CrossRef Lee YL, Yip KM (1996) The osteoporotic spine. Clin Orthop Relat Res 323:91–97CrossRef
3.
go back to reference Sudo H, Ito M, Abumi K et al (2010) One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. Eur Spine J 19:907–915CrossRefPubMedPubMedCentral Sudo H, Ito M, Abumi K et al (2010) One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. Eur Spine J 19:907–915CrossRefPubMedPubMedCentral
4.
go back to reference Uchida K, Nakajima H, Yayama T et al (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 13:612–621CrossRefPubMed Uchida K, Nakajima H, Yayama T et al (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 13:612–621CrossRefPubMed
5.
go back to reference Baba H, Maezawa Y, Kamitani K et al (1995) Osteoporotic vertebral collapse with late neurological complications. Paraplegia 33:281–289CrossRefPubMed Baba H, Maezawa Y, Kamitani K et al (1995) Osteoporotic vertebral collapse with late neurological complications. Paraplegia 33:281–289CrossRefPubMed
6.
go back to reference Kaneda K, Asano S, Hashimoto T et al (1992) The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis. Spine 17:S295–S303CrossRefPubMed Kaneda K, Asano S, Hashimoto T et al (1992) The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis. Spine 17:S295–S303CrossRefPubMed
7.
go back to reference Taneichi H, Kaneda K, Oguma T et al (2000) Risk factor analysis for osteoporotic vertebral collapse and pseudoarthrosis (in Japanese). Rinsyo Seikeigeka 37:437–442 Taneichi H, Kaneda K, Oguma T et al (2000) Risk factor analysis for osteoporotic vertebral collapse and pseudoarthrosis (in Japanese). Rinsyo Seikeigeka 37:437–442
8.
go back to reference Kashii M, Yamazaki R, Yamashita T et al (2013) Surgical treatment for osteoporotic vertebral collapse with neurological deficits: retrospective comparative study of three procedures—anterior surgery versus posterior spinal shorting osteotomy versus posterior spinal fusion using vertebroplasty. Eur Spine J 22:1633–1642CrossRefPubMedPubMedCentral Kashii M, Yamazaki R, Yamashita T et al (2013) Surgical treatment for osteoporotic vertebral collapse with neurological deficits: retrospective comparative study of three procedures—anterior surgery versus posterior spinal shorting osteotomy versus posterior spinal fusion using vertebroplasty. Eur Spine J 22:1633–1642CrossRefPubMedPubMedCentral
9.
go back to reference McDonnell MF, Glassman SD, Dimar JR 2nd et al (1996) Perioperative complications of anterior procedures in the spine. J Bone Joint Surg Am 78:839–847PubMed McDonnell MF, Glassman SD, Dimar JR 2nd et al (1996) Perioperative complications of anterior procedures in the spine. J Bone Joint Surg Am 78:839–847PubMed
10.
go back to reference Okuda S, Oda T, Yamasaki R et al (2012) Surgical outcomes of osteoporotic vertebral collapse: a retrospective study of anterior spinal fusion and pedicle subtraction osteotomy. Global Spine J 2:221–226CrossRefPubMedPubMedCentral Okuda S, Oda T, Yamasaki R et al (2012) Surgical outcomes of osteoporotic vertebral collapse: a retrospective study of anterior spinal fusion and pedicle subtraction osteotomy. Global Spine J 2:221–226CrossRefPubMedPubMedCentral
11.
go back to reference Oda I, Fujiya M, Hasegawa K et al (2008) Surgical treatment for pseudoarthrosis of osteoporotic vertebral fractures-posterior decompression and vertebroplasty with instrumentation. J Jpn Spine Res Soc 19:646–658 Oda I, Fujiya M, Hasegawa K et al (2008) Surgical treatment for pseudoarthrosis of osteoporotic vertebral fractures-posterior decompression and vertebroplasty with instrumentation. J Jpn Spine Res Soc 19:646–658
12.
go back to reference Ataka H, Tanno T, Yamazaki M (2009) Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. Eur Spine J 18:69–76CrossRefPubMed Ataka H, Tanno T, Yamazaki M (2009) Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. Eur Spine J 18:69–76CrossRefPubMed
13.
go back to reference Fukui M, Chiba K, Kawakami M et al (2007) JOA back pain evaluation questionnaire: initial report. Clinical Outcomes Committee of the Japanese Orthopaedic Association, Subcommittee on Evaluation of Back Pain and Cervical Myelopathy; Subcommittee on Low Back Pain and Cervical Myelopathy Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association. J Orthop Sci 12:443–450CrossRefPubMedPubMedCentral Fukui M, Chiba K, Kawakami M et al (2007) JOA back pain evaluation questionnaire: initial report. Clinical Outcomes Committee of the Japanese Orthopaedic Association, Subcommittee on Evaluation of Back Pain and Cervical Myelopathy; Subcommittee on Low Back Pain and Cervical Myelopathy Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association. J Orthop Sci 12:443–450CrossRefPubMedPubMedCentral
14.
go back to reference Bradford DS, McBride GG (1987) Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop Relat Res 218:201–216 Bradford DS, McBride GG (1987) Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop Relat Res 218:201–216
15.
go back to reference Sudo H, Ito M, Kaneda K et al (2013) Anterior decompression and strut graft versus posterior decompression and pedicle screw fixation with vertebroplasty for osteoporotic thoracolumbar vertebral collapse with neurologic deficits. Spine J 13:1726–1732CrossRefPubMed Sudo H, Ito M, Kaneda K et al (2013) Anterior decompression and strut graft versus posterior decompression and pedicle screw fixation with vertebroplasty for osteoporotic thoracolumbar vertebral collapse with neurologic deficits. Spine J 13:1726–1732CrossRefPubMed
16.
go back to reference Chang KW, Chen YY, Lin CC et al (2005) Apical lordosating osteotomy and minimal segment fixation for the treatment of thoracic or thoracolumbar osteoporotic kyphosis. Spine 30:1674–1681CrossRefPubMed Chang KW, Chen YY, Lin CC et al (2005) Apical lordosating osteotomy and minimal segment fixation for the treatment of thoracic or thoracolumbar osteoporotic kyphosis. Spine 30:1674–1681CrossRefPubMed
17.
go back to reference Suk SI, Kim JH, Lee JH et al (2003) Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine 28:2170–2175CrossRefPubMed Suk SI, Kim JH, Lee JH et al (2003) Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine 28:2170–2175CrossRefPubMed
Metadata
Title
Surgical treatment for osteoporotic thoracolumbar vertebral collapse using vertebroplasty with posterior spinal fusion: a prospective multicenter study
Authors
Keiichi Katsumi
Toru Hirano
Kei Watanabe
Masayuki Ohashi
Akiyoshi Yamazaki
Takui Ito
Kimihiko Sawakami
Atsuki Sano
Ren Kikuchi
Naoto Endo
Publication date
01-11-2016
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 11/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-016-3222-3

Other articles of this Issue 11/2016

International Orthopaedics 11/2016 Go to the issue