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

Clinical article

Kenzo Uchida M.D., Ph.D., Hideaki Nakajima M.D., Ph.D., Takafumi Yayama M.D., Ph.D., Tsuyoshi Miyazaki M.D., Ph.D., Takayuki Hirai M.D., Shigeru Kobayashi M.D., Ph.D., Kebing Chen M.D., Alexander Rodriguez Guerrero M.D., and Hisatoshi Baba M.D., Ph.D.
View More View Less
  • Department of Orthopaedics and Rehabilitation Medicine, Fukui University Faculty of Medical Sciences, Fukui, Japan
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The surgical approach and treatment of thoracolumbar osteoporotic vertebral collapse with neurological deficit have not been documented in detail. Anterior surgery provides good decompression and solid fusion, but the surgery-related risk is relatively higher than that associated with the posterior approach. In posterior surgery, the major problem after posterior correction and instrumentation is failure to support the anterior spinal column, leading to loss of correction of kyphosis. The aim of this study was to evaluate the efficacy of reinforcing short-segment posterior fixation with vertebroplasty and to compare the outcome with those of posterior surgery without vertebroplasty and anterior surgery, retrospectively.

Methods

The authors studied 83 patients who underwent surgical treatment for a single thoracolumbar osteoporotic vertebral collapse with neurological deficit. Twenty-eight patients treated by posterior surgery combined with vertebroplasty (Group A), 25 patients treated by posterior surgery without vertebroplasty (Group B), and 30 patients treated by anterior surgery (Group C) were followed up for a mean postoperative period of 4.4 years. Neurological outcome, visual analog scale pain score, and radiographic results were compared in the 3 groups.

Results

Postoperative (4–6 weeks) and follow-up neurological outcome and visual analog scale scores were not significantly different among the 3 groups. Postoperative kyphotic angle was significantly reduced in Group B compared with Group C (p = 0.007), whereas the kyphotic angle was not significantly different among the 3 groups at follow-up. The mean ± SD loss of correction at follow-up was 4.6° ± 4.5°, 8.6° ± 6.2°, and 4.5° ± 5.9° in Groups A, B, and C, respectively. The correction loss at follow-up in Group B was significantly higher compared with Groups A and C (p = 0.0171 and p = 0.0180, respectively).

Conclusions

The results suggest that additional reinforcement with vertebroplasty reduces the kyphotic loss and instrumentation failure, compared with patients without the reinforcement of vertebroplasty. Vertebroplasty-augmented short-segment fixation seems to offer immediate spinal stability in patients with thoracolumbar osteoporotic vertebral collapse; the effect seems equivalent to that of anterior reconstruction.

Abbreviations used in this paper: BMD = bone mineral density; CPC = calcium phosphate cement; HA = hydroxyapatite; PLF = posterolateral fusion; PMMA = polymethylmethacrylate; PS = pedicle screw; VAS = visual analog scale.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Kenzo Uchida, M.D., Ph.D., Department of Orthopaedics and Rehabilitation Medicine, Fukui University Faculty of Medical Sciences, Matsuoka Shimoaizuki 23-3, Eiheiji, Fukui 910-1193, Japan. email: kuchida@u-fukui.ac.jp.
  • 1

    Arciero RA, , Leung KY, & Pierce JH: Spontaneous unstable burst fracture of the thoracolumbar spine in osteoporosis. A report of two cases. Spine 14:114117, 1989

    • Search Google Scholar
    • Export Citation
  • 2

    Baba H, , Maezawa Y, , Kamitani K, , Furusawa N, , Imura S, & Tomita K: Osteoporotic vertebral collapse with late neurological complications. Paraplegia 33:281289, 1995

    • Search Google Scholar
    • Export Citation
  • 3

    Belkoff SM, , Mathis JM, , Jasper LE, & Deramond H: The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine 26:15371541, 2001

    • Search Google Scholar
    • Export Citation
  • 4

    Belkoff SM, , Mathis JM, , Jasper LE, & Deramond H: An ex vivo biomechanical evaluation of a hydroxyapatite cement for use with vertebroplasty. Spine 26:15421546, 2001

    • Search Google Scholar
    • Export Citation
  • 5

    Benson DR, , Burkus JK, , Montesano PX, , Sutherland TB, & McLain RF: Unstable thoracolumbar and lumbar burst fractures treated with the AO fixateur interne. J Spinal Disord 5:335343, 1992

    • Search Google Scholar
    • Export Citation
  • 6

    Chiba M, , McLain RF, , Yerby SA, , Moseley TA, , Smith TS, & Benson DR: Short-segment pedicle instrumentation. Biomechanical analysis of supplemental hook fixation. Spine 21:288294, 1996

    • Search Google Scholar
    • Export Citation
  • 7

    Chiras J, , Depriester C, , Weill A, , Sola-Martinez MT, & Deramond H: [Percutaneous vertebral surgery. Technics and indications.]. J Neuroradiol 24:4559, 1997. (Fr)

    • Search Google Scholar
    • Export Citation
  • 8

    Cho DY, , Lee WY, & Sheu PC: Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation. Neurosurgery 53:13541361, 2003

    • Search Google Scholar
    • Export Citation
  • 9

    Chou LH, & Knight RQ: Idiopathic avascular necrosis of a vertebral body. Case report and literature review. Spine 22:19281932, 1997

  • 10

    Coe JD, , Warden KE, , Herzig MA, & McAfee PC: Influence of bone mineral density on the fixation of thoracolumbar implants. A comparative study of transpedicular screws, laminar hooks, and spinous process wires. Spine 15:902907, 1990

    • Search Google Scholar
    • Export Citation
  • 11

    Daniaux H, , Seykora P, , Genelin A, , Lang T, & Kathrein A: Application of posterior plating and modifications in thoracolumbar spine injuries. Indication, techniques, and results. Spine 16:3 Suppl S125S133, 1991

    • Search Google Scholar
    • Export Citation
  • 12

    Frost HM: Clinical management of the symptomatic osteoporotic patient. Orthop Clin North Am 12:671681, 1981

  • 13

    Garfin SR, , Yuan HA, & Reiley MA: New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26:15111515, 2001

    • Search Google Scholar
    • Export Citation
  • 14

    Halvorson TL, , Kelley LA, , Thomas KA, , Whitecloud TS III, & Cook SD: Effects of bone mineral density on pedicle screw fixation. Spine 19:24152420, 1994

    • Search Google Scholar
    • Export Citation
  • 15

    Heini PF: The current treatment—a survey of osteoporotic fracture treatment. Osteoporotic spine fractures: the spine surgeon's perspective. Osteoporos Int 16:Suppl 2 S85S92, 2005

    • Search Google Scholar
    • Export Citation
  • 16

    Hu SS: Internal fixation in the osteoporotic spine. Spine 22:24 Suppl 43S48S, 1997

  • 17

    Ito M, , Kotani Y, , Hojo Y, , Abumi K, , Kadosawa T, & Minami A: Evaluation of hydroxyapatite ceramic vertebral spacers with different porosities and their binding capability to the vertebral body: an experimental study in sheep. J Neurosurg Spine 6:431437, 2007

    • Search Google Scholar
    • Export Citation
  • 18

    Japanese Orthopaedic Association: [Criteria on the evaluation of treatment of cervical myelopathy.]. Nippon Seikeigeka Gakkai Zasshi 50:addendum no. 5 1976. (Jpn)

    • Search Google Scholar
    • Export Citation
  • 19

    Jensen ME, , Evans AJ, , Mathis JM, , Kallmes DF, , Cloft HJ, & Dion JE: Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 18:18971904, 1997

    • Search Google Scholar
    • Export Citation
  • 20

    Kaneda K, , Asano S, , Hashimoto T, , Satoh S, & Fujiya M: The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis. Spine 17:8 Suppl S295S303, 1992

    • Search Google Scholar
    • Export Citation
  • 21

    Kaneda K, , Taneichi H, , Abumi K, , Hashimoto T, , Satoh S, & Fujiya M: Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Joint Surg Am 79:6983, 1997

    • Search Google Scholar
    • Export Citation
  • 22

    Kempinsky WH, , Morgan PP, & Boniface WR: Osteoporotic kyphosis with paraplegia. Neurology 8:181186, 1958

  • 23

    Kim KT, , Suk KS, , Kim JM, & Lee SH: Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop 27:6569, 2003

    • Search Google Scholar
    • Export Citation
  • 24

    Lee YL, & Yip KM: The osteoporotic spine. Clin Orthop Relat Res 323:9197, 1996

  • 25

    Lieberman IH, , Dudeney S, , Reinhardt MK, & Bell G: Initial outcome and efficacy of “kyphoplasty” in the treatment of painful osteoporotic vertebral compression fractures. Spine 26:16311638, 2001

    • Search Google Scholar
    • Export Citation
  • 26

    Lu WW, , Cheung KM, , Li YW, , Luk KD, , Holmes AD, & Zhu QA, : Bioactive bone cement as a principal fixture for spinal burst fracture: an in vitro biomechanical and morphologic study. Spine 26:26842691, 2001

    • Search Google Scholar
    • Export Citation
  • 27

    Matsuyama Y, , Goto M, , Yoshihara H, , Tsuji T, , Sakai Y, & Nakamura H, : Vertebral reconstruction with biodegradable calcium phosphate cement in the treatment of osteoporotic vertebral compression fracture using instrumentation. J Spinal Disord Tech 17:291296, 2004

    • Search Google Scholar
    • Export Citation
  • 28

    McLain RF, , Sparling E, & Benson DR: Early failure of shortsegment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am 75:162167, 1993

    • Search Google Scholar
    • Export Citation
  • 29

    Mermelstein LE, , McLain RF, & Yerby SA: Reinforcement of thoracolumbar burst fractures with calcium phosphate cement. A biomechanical study. Spine 23:664671, 1998

    • Search Google Scholar
    • Export Citation
  • 30

    Million R, , Hall W, , Nilsen KH, , Baker RD, & Jayson MI: Assessment of the progress of the back-pain patient 1981 Volvo Award in Clinical Science. Spine 7:204212, 1982

    • Search Google Scholar
    • Export Citation
  • 31

    Mochida J, , Toh E, , Chiba M, & Nishimura K: Treatment of osteoporotic late collapse of a vertebral body of thoracic and lumbar spine. J Spinal Disord 14:393398, 2001

    • Search Google Scholar
    • Export Citation
  • 32

    O'Connor PA, , Eustace S, & O'Byrne J: Spinal cord injury following osteoporotic vertebral fracture: case report. Spine 27:E413E415, 2002

    • Search Google Scholar
    • Export Citation
  • 33

    Okuyama K, , Sato K, , Abe E, , Inaba H, , Shimada Y, & Murai H: Stability of transpedicle screwing for the osteoporotic spine. An in vitro study of the mechanical stability. Spine 18:22402245, 1993

    • Search Google Scholar
    • Export Citation
  • 34

    Peh WC, , Gilula LA, & Peck DD: Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology 223:121126, 2002

    • Search Google Scholar
    • Export Citation
  • 35

    Riggs BL, , Jowsey J, , Kelly PJ, & Hoffman DL: Treatment for postmenopausal and senile osteoporosis. Med Clin North Am 56:989997, 1972

  • 36

    Saita K, , Hoshino Y, , Kikkawa I, & Nakamura H: Posterior spinal shortening for paraplegia after vertebral collapse caused by osteoporosis. Spine 25:28322835, 2000

    • Search Google Scholar
    • Export Citation
  • 37

    Saville PD: A quantitative approach to simple radiographic diagnosis of osteoporosis: its application to the osteoporosis of rheumatoid arthritis. Arthritis Rheum 10:416422, 1967

    • Search Google Scholar
    • Export Citation
  • 38

    Shikata J, , Yamamuro T, , Iida H, , Shimizu K, & Yoshikawa J: Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis. Spine 15:485489, 1990

    • Search Google Scholar
    • Export Citation
  • 39

    Soshi S, , Shiba R, , Kondo H, & Murota K: An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar spine. Spine 16:13351341, 1991

    • Search Google Scholar
    • Export Citation
  • 40

    Suk SI, , Kim JH, , Lee SM, , Chung ER, & Lee JH: Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine 28:21702175, 2003

    • Search Google Scholar
    • Export Citation
  • 41

    Toyone T, , Tanaka T, , Kato D, , Kaneyama R, & Otsuka M: The treatment of acute thoracolumbar burst fractures with transpedicular intracorporeal hydroxyapatite grafting following indirect reduction and pedicle screw fixation: a prospective study. Spine 31:E208E214, 2006

    • Search Google Scholar
    • Export Citation
  • 42

    Uchida K, , Kobayashi S, , Matsuzaki M, , Nakajima H, , Shimada S, & Yayama T, : Anterior versus posterior surgery for osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine. Eur Spine J 15:17591767, 2006

    • Search Google Scholar
    • Export Citation
  • 43

    Uchida K, , Kobayashi S, , Nakajima H, , Kokubo Y, , Yayama T, & Sato R, : Anterior expandable strut cage replacement for osteoporotic thoracolumbar vertebral collapse. J Neurosurg Spine 4:454462, 2006

    • Search Google Scholar
    • Export Citation
  • 44

    Verlaan JJ, , Dhert WJ, , Verbout AJ, & Oner FC: Balloon vertebroplasty in combination with pedicle screw instrumentation: a novel technique to treat thoracic and lumbar burst fractures. Spine 30:E73E79, 2005

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 536 193 13
Full Text Views 179 35 2
PDF Downloads 198 48 1
EPUB Downloads 0 0 0