Document Detail


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.
MedLine Citation:
PMID:  21039153     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Kenzo Uchida; Hideaki Nakajima; Takafumi Yayama; Tsuyoshi Miyazaki; Takayuki Hirai; Shigeru Kobayashi; Kebing Chen; Alexander Rodriguez Guerrero; Hisatoshi Baba
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery. Spine     Volume:  13     ISSN:  1547-5646     ISO Abbreviation:  J Neurosurg Spine     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-02     Completed Date:  2010-11-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101223545     Medline TA:  J Neurosurg Spine     Country:  United States    
Other Details:
Languages:  eng     Pagination:  612-21     Citation Subset:  IM    
Affiliation:
Department of Orthopaedics and Rehabilitation Medicine, Fukui University Faculty of Medical Sciences, Fukui, Japan. kuchida@u-fukui.ac.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Decompression, Surgical / standards
Equipment Failure
Follow-Up Studies
Humans
Joint Instability / etiology
Kyphosis / etiology,  radiography,  surgery
Lumbar Vertebrae / injuries*
Magnetic Resonance Imaging
Male
Middle Aged
Nervous System Diseases / diagnosis,  etiology*,  physiopathology
Orthopedic Fixation Devices / adverse effects
Orthopedic Procedures* / adverse effects
Osteoporosis / complications*
Reconstructive Surgical Procedures / standards
Retrospective Studies
Spinal Fractures / etiology*,  radiography,  surgery*
Thoracic Vertebrae / injuries*
Tomography, X-Ray Computed
Vertebroplasty*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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