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Erschienen in: European Spine Journal 7/2013

01.07.2013 | Original Article

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

verfasst von: Masafumi Kashii, Ryoji Yamazaki, Tomoya Yamashita, Shinya Okuda, Takahito Fujimori, Yukitaka Nagamoto, Yuichi Tamura, Takenori Oda, Tetsuo Ohwada, Hideki Yoshikawa, Motoki Iwasaki

Erschienen in: European Spine Journal | Ausgabe 7/2013

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Abstract

Purpose

In general, osteoporotic vertebral collapse (OVC) with neurological deficits requires sufficient decompression of neural tissues to restore function level in activities of daily living (ADL). However, it remains unclear as to which procedure provides better neurological recovery. The primary purpose of this study was to compare neurological recovery among three typical procedures for OVC with neurological deficits. Secondary purpose was to compare postoperative ADL function.

Methods

We retrospectively reviewed data for 88 patients (29 men and 59 women) with OVC and neurological deficits who underwent surgery. Three typical kinds of surgical procedures with different decompression methods were used: (1) anterior direct neural decompression and reconstruction (AR group: 27 patients), (2) posterior spinal shorting osteotomy with direct neural decompression (PS group: 36 patients), and (3) posterior indirect neural decompression and short-segment spinal fusion combined with vertebroplasty (VP group: 25 patients). We examined clinical results regarding neurological deficits and function level in ADL and radiological results.

Results

The mean improvement rates for neurological deficits and ADL function level were 60.1 and 55.0 %, respectively. There were no significant differences among three groups in improvement rates for neurological deficits or ADL function level. The VP group had a significantly lower estimated mean blood loss (338 mL) and mean duration of surgery (229 min) than both the AR and PS groups (p < 0.001).

Conclusion

Direct neural decompression is not always necessary, and the majority of patients can be treated with a less-invasive procedure such as short-segment posterior spinal fusion with indirect decompression combined with vertebroplasty. The high-priority issue is careful evaluation of patients’ general health and osteoporosis severity, so that the surgeon can choose the procedure best suited for each patient.
Literatur
2.
Zurück zum Zitat Taneichi H, Kaneda K, Oguma T, Kokaji M (2002) Risk factor analysis for osteoporotic vertebral collapse and pseudarthrosis. Rinsyo Seikeigeka 37:437–442 Taneichi H, Kaneda K, Oguma T, Kokaji M (2002) Risk factor analysis for osteoporotic vertebral collapse and pseudarthrosis. Rinsyo Seikeigeka 37:437–442
3.
Zurück zum Zitat Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh S, Fujiya M et al (1997) Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Jt Surg Am 79:69–83 Kaneda K, Taneichi H, Abumi K, Hashimoto T, Satoh S, Fujiya M et al (1997) Anterior decompression and stabilization with the Kaneda device for thoracolumbar burst fractures associated with neurological deficits. J Bone Jt Surg Am 79:69–83
4.
Zurück zum Zitat Kanayama M, Ishida T, Hashimoto T, Shigenobu K, Togawa D, Oha F et al (2010) Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebral collapse. J Spinal Disord Tech 23:53–56PubMedCrossRef Kanayama M, Ishida T, Hashimoto T, Shigenobu K, Togawa D, Oha F et al (2010) Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebral collapse. J Spinal Disord Tech 23:53–56PubMedCrossRef
5.
Zurück zum Zitat Suk SI, Kim JH, Lee SM, Chung ER, Lee JH (2003) Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine 28:2170–2175PubMedCrossRef Suk SI, Kim JH, Lee SM, Chung ER, Lee JH (2003) Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine 28:2170–2175PubMedCrossRef
6.
Zurück zum Zitat Uchida K, Nakajima H, Yayama T, Miyzaki T, Hirai T, Kobayashi S 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 13:612–621PubMedCrossRef Uchida K, Nakajima H, Yayama T, Miyzaki T, Hirai T, Kobayashi S 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 13:612–621PubMedCrossRef
7.
Zurück zum Zitat Saita K, Hoshino Y, Kikkawa I, Nakamura H (2000) Posterior spinal shortening for paraplegia after vertebral collapse caused by osteoporosis. Spine 25:2832–2835PubMedCrossRef Saita K, Hoshino Y, Kikkawa I, Nakamura H (2000) Posterior spinal shortening for paraplegia after vertebral collapse caused by osteoporosis. Spine 25:2832–2835PubMedCrossRef
8.
Zurück zum Zitat Shikata J, Yamamuro T, Iida H, Shimizu K, Yoshikawa J (1990) Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis. Spine 15:485–489PubMedCrossRef Shikata J, Yamamuro T, Iida H, Shimizu K, Yoshikawa J (1990) Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis. Spine 15:485–489PubMedCrossRef
9.
Zurück zum Zitat Kim KT, Suk KS, Kim JM, Lee SH (2003) Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop 27:65–69PubMed Kim KT, Suk KS, Kim JM, Lee SH (2003) Delayed vertebral collapse with neurological deficits secondary to osteoporosis. Int Orthop 27:65–69PubMed
10.
Zurück zum Zitat Matsuyama Y, Goto M, Yoshihara H, Tsuji T, Sakai Y, Nakamura H et al (2004) Vertebral reconstruction with biodegradable calcium phosphate cement in the treatment of osteoporotic vertebral compression fracture using instrumentation. J Spinal Disord Tech 17:291–296PubMedCrossRef Matsuyama Y, Goto M, Yoshihara H, Tsuji T, Sakai Y, Nakamura H et al (2004) Vertebral reconstruction with biodegradable calcium phosphate cement in the treatment of osteoporotic vertebral compression fracture using instrumentation. J Spinal Disord Tech 17:291–296PubMedCrossRef
11.
Zurück zum Zitat Korovessis P, Hadjipavlou A, Repantis T (2008) Minimal invasive short posterior instrumentation plus balloon kyphoplasty with calcium phosphate for burst and severe compression lumbar fractures. Spine 33:658–667PubMedCrossRef Korovessis P, Hadjipavlou A, Repantis T (2008) Minimal invasive short posterior instrumentation plus balloon kyphoplasty with calcium phosphate for burst and severe compression lumbar fractures. Spine 33:658–667PubMedCrossRef
12.
Zurück zum Zitat Lee SH, Kim ES, Eoh W (2011) Cement augmented anterior reconstruction with short posterior instrumentation: a less invasive surgical option for Kummell’s disease with cord compression. J Clin Neurosci 18:509–514PubMedCrossRef Lee SH, Kim ES, Eoh W (2011) Cement augmented anterior reconstruction with short posterior instrumentation: a less invasive surgical option for Kummell’s disease with cord compression. J Clin Neurosci 18:509–514PubMedCrossRef
13.
Zurück zum Zitat Sudo H, Ito M, Abumi K, Kotani Y, Takahata M, Hojo Y et al (2010) One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. Eur Spine J 19:907–915PubMedCrossRef Sudo H, Ito M, Abumi K, Kotani Y, Takahata M, Hojo Y et al (2010) One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. Eur Spine J 19:907–915PubMedCrossRef
14.
Zurück zum Zitat Yang SC, Chen WJ, Yu SW, Tu YK, Kao YH, Chung KC (2008) Revision strategies for complications and failure of vertebroplasties. Eur Spine J 17:982–988PubMedCrossRef Yang SC, Chen WJ, Yu SW, Tu YK, Kao YH, Chung KC (2008) Revision strategies for complications and failure of vertebroplasties. Eur Spine J 17:982–988PubMedCrossRef
15.
Zurück zum Zitat Bradford DS, McBride GG (1987) Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop Relat Res 218:201–216PubMed Bradford DS, McBride GG (1987) Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop Relat Res 218:201–216PubMed
16.
Zurück zum Zitat Campbell JC, Ikegami N (2000) Long-term care insurance comes to Japan. Health Aff (Millwood) 19:26–39CrossRef Campbell JC, Ikegami N (2000) Long-term care insurance comes to Japan. Health Aff (Millwood) 19:26–39CrossRef
17.
Zurück zum Zitat Matsumoto T, Hoshino M, Tsujio T (2012) Prognostic factors for reduction of activities of daily living following osteoporotic vertebral fractures. Spine 37:1115–1121PubMedCrossRef Matsumoto T, Hoshino M, Tsujio T (2012) Prognostic factors for reduction of activities of daily living following osteoporotic vertebral fractures. Spine 37:1115–1121PubMedCrossRef
18.
Zurück zum Zitat 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 18:69–76PubMedCrossRef 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 18:69–76PubMedCrossRef
19.
Zurück zum Zitat Hoshino M, Nakamura H, Terai H, Tsujio T, Nabeta M, Namikawa T et al (2009) Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture. Eur Spine J 18:1279–1286PubMedCrossRef Hoshino M, Nakamura H, Terai H, Tsujio T, Nabeta M, Namikawa T et al (2009) Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture. Eur Spine J 18:1279–1286PubMedCrossRef
20.
Zurück zum Zitat Saito F, Takahashi K, Tanaka S, Torio T, Iizuka H, Wei C et al (2011) Effects of vertebroplasty for delayed-onset paraplegia caused by vertebral pseudarthrosis. J Orthop Sci 16:673–681PubMedCrossRef Saito F, Takahashi K, Tanaka S, Torio T, Iizuka H, Wei C et al (2011) Effects of vertebroplasty for delayed-onset paraplegia caused by vertebral pseudarthrosis. J Orthop Sci 16:673–681PubMedCrossRef
21.
Zurück zum Zitat Neviaser A, Toro-Arbelaez JB, Lane JM (2005) Is kyphoplasty the standard of care for compression fractures in the spine, especially in the elderly? Am J Orthop 34:425–429PubMed Neviaser A, Toro-Arbelaez JB, Lane JM (2005) Is kyphoplasty the standard of care for compression fractures in the spine, especially in the elderly? Am J Orthop 34:425–429PubMed
22.
Zurück zum Zitat Nguyen HV, Ludwig S, Gelb D (2003) Osteoporotic vertebral burst fractures with neurologic compromise. J Spinal Disord Tech 16:10–19PubMedCrossRef Nguyen HV, Ludwig S, Gelb D (2003) Osteoporotic vertebral burst fractures with neurologic compromise. J Spinal Disord Tech 16:10–19PubMedCrossRef
Metadaten
Titel
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
verfasst von
Masafumi Kashii
Ryoji Yamazaki
Tomoya Yamashita
Shinya Okuda
Takahito Fujimori
Yukitaka Nagamoto
Yuichi Tamura
Takenori Oda
Tetsuo Ohwada
Hideki Yoshikawa
Motoki Iwasaki
Publikationsdatum
01.07.2013
Verlag
Springer Berlin Heidelberg
Erschienen in
European Spine Journal / Ausgabe 7/2013
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-013-2759-8

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