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1
Laws, Nicola, and Andrew Hoey. "Progression of kyphosis in mdx mice." Journal of Applied Physiology 97, no. 5 (November 2004): 1970–77. http://dx.doi.org/10.1152/japplphysiol.01357.2003.
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Spinal deformity in the form of kyphosis or kyphoscoliosis occurs in most patients with Duchenne muscular dystrophy (DMD), a fatal X-linked disorder caused by an absence of the subsarcolemmal protein dystrophin. Mdx mice, which also lack dystrophin, show thoracolumbar kyphosis that progresses with age. We hypothesize that paraspinal and respiratory muscle weakness and fibrosis are associated with the progression of spinal deformity in this mouse model, and similar to DMD patients there is evidence of altered thoracic conformation and area. We measured kyphosis in mdx and age-matched control mice by monthly radiographs and the application of a novel radiographic index, the kyphotic index, similar to that used in boys with DMD. Kyphotic index became significantly less in mdx at 9 mo of age (3.58 ± 0.12 compared with 4.27 ± 0.04 in the control strain; P ≤ 0.01), indicating more severe kyphosis, and remained less from 10 to 17 mo of age. Thoracic area in 17-mo-old mdx was reduced by 14% compared with control mice ( P ≤ 0.05). Peak tetanic tension was significantly lower in mdx and fell 47% in old mdx latissimus dorsi muscles, 44% in intercostal strips, and 73% in diaphragm strips ( P ≤ 0.05). Fibrosis of these muscles and the longissimus dorsi, measured by hydroxyproline analysis and histological grading of picrosirius red-stained sections, was greater in mdx ( P < 0.05). We conclude that kyphotic index is a useful measure in mdx and other kyphotic mouse strains, and assessment of paralumbar and accessory respiratory muscles enhance understanding of spinal deformity in muscular dystrophy.
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Byval’tsev, V. A., A. A. Kalinin, V. A. Sorokovikov, E. G. Belykh, S. Yu Panasenkov, and E. G. Griror’ev. "Analysis of Results of Kyphotic Deformity Reduction Using Puncture Vertebroplasty and Stenoplasty in Patients with Traumatic Compression Fractures of Thoraco-Lumbar Localization." N.N. Priorov Journal of Traumatology and Orthopedics 21, no. 2 (June 15, 2014): 12–18. http://dx.doi.org/10.17816/vto20140212-18.
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Correction of posttraumatic deformity and stabilization of injured segment play an important role in treatment and complication prevention after traumatic compression vertebral body fractures. Possibilities of deformity reduction using vertebroplasty and a combination of distractive titanium cage with insertion of bone cement into vertebral body (stenoplasty) are not well studied. Retrospective comparative analysis of clinical efficacy and degree of kyphotic deformity reduction using puncture vertebroplasty (1 st group, n=15) and stenoplasty (2 nd group, n=15) in patients with traumatic A1 compression fractures of thoraco-lumbar vertebral bodies was performed. Severity of pain syndrome (VAS) and degree of injured segment deformity (kyphotic angle and wedge-shaping index) were assessed. In both groups surgical intervention resulted in marked pain reduction but in long-term period it was less significant for 2 nd group (p=0.0035). Postoperatively kyphotic angle median and wedge-shaping index changed statistically significant in 2 nd group from 12.60 (10.50; 13.40) to 2.50 (1.90; 3.20) (p=0.0015) and from 25.3% (22.8; 26.7) to 9.3% (8.9; 11.4) (p=0.0022), respectively and not significantly in 1 st group from 13.10 (11.40; 14.30) to 12.90 (11.20; 14.00) (p= 0.93) and from 26.5% (24.0; 28.8) to 25.9% (23.8; 28.4) (p=0.86), respectively. Progression of posttraumatic kyphosis in late postoperative period was noted in 1 st group (P M Ü=0.042) but not in 2nd group (P =0.58). In traumatic A1 compression fractures stenoplasty enabled to perform kyphotic deformity correction in the early period of spinal injury, to achieve significantly greater reduction of kyphotic angle and to preserve the result in remote postoperative period as compared to puncture vertebroplasty
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Choi, Man Kyu, Dae Jean Jo, and Chang Kyu Park. "Late-onset neurological deficits induced by proximal adjacent segment degeneration related to severe post-tuberculous kyphotic deformities of the spine: a series of 7 cases and surgical correction concept." Journal of Neurosurgery: Spine 31, no. 3 (September 2019): 418–23. http://dx.doi.org/10.3171/2019.3.spine18937.
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OBJECTIVELate-onset neurological deficits are a rare complication of spinal tuberculosis that may be caused by proximal adjacent segment degeneration (ASD) above the kyphus. The objective of this study was to report several cases of neurological deficits due to proximal ASD in patients with post-tuberculous kyphotic deformity and discuss the characteristics of the authors’ corrective surgical technique.METHODSThe inclusion criteria in this study were severe angular kyphosis due to a post-tuberculous kyphotic deformity and a late-onset neurological deficit. The cause of these deficits was related to a lesion in the proximal cephalad portion of the kyphotic deformity. Surgical intervention, including decompression and compromised restoration of the sagittal imbalance, was performed in all patients. Preoperative surgical planning with a radiological evaluation included CT, plain radiograph, and MRI studies. Clinical outcomes were evaluated using the American Spinal Injury Association Impairment Scale and the Oswestry Disability Index (ODI).RESULTSThe main goal of our surgical technique was the correction of sagittal malalignment by positioning the patient’s head above the kyphotic deformity on the sagittal plane, excluding aggressive osteotomy. The neurological symptoms showed immediate improvements postoperatively, except in 1 patient. Compared to the preoperative value of 66.9, the mean ODI score improved to 42.6 at the final follow-up for all patients. Preoperatively, the mean values of the angles of deformity and the sagittal vertical axis were 99.7° and 157.7 mm, respectively, and decreased to 75.3° and 46.0 mm, respectively, at the final follow-up. No major complications were observed, and the patients’ self-satisfaction was high with respect to both cosmetic and functional outcomes.CONCLUSIONSClinicians should be aware of the degeneration of the vertebrae above the kyphotic segment in patients with post-tuberculosis deformity. Successful neurological recovery and compromised sagittal balance could be obtained by using our “head on kyphus” surgical concept.
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Sapkas, George, Konstantinos Kateros, Stamatios A. Papadakis, Emmanouel Brilakis, George Macheras, and Pavlos Katonis. "Treatment of Unstable Thoracolumbar Burst Fractures by Indirect Reduction and Posterior Stabilization: Short-Segment Versus Long-Segment Stabilization." Open Orthopaedics Journal 4, no. 1 (January 15, 2010): 7–13. http://dx.doi.org/10.2174/1874325001004010007.
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In order to compare short-segment stabilization with long-segment stabilization for treating unstable thoracolumbar fractures, we studied fifty patients suffered from unstable thoracolumbar burst fractures. Thirty of them were managed with long-segment posterior transpedicular instrumentation and twenty patients with short- segment stabilization. The mean follow up period was 5.2 years. Pre-operative and post-operative radiological parameters, like the Cobb angle, the kyphotic deformation and the Beck index were evaluated. A statistically significant difference between the two under study groups was noted for the Cobb angle and the kyphotic deformation, while, as far as the Beck index is concerned, no significant difference was noted. In conclusion, either the long-segment or the short-segment stabilization is able for reducing the segmental kyphosis and the vertebral body deformation postoperatively. However, as time goes by, the long-segment stabilization is associated with better results as far as the radiological parameters, the indexes and the patient’s satisfaction are concerned.
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Wang, Xiang-Yang, Li-Yang Dai, Hua-Zi Xu, and Yong-Long Chi. "Kyphosis recurrence after posterior short-segment fixation in thoracolumbar burst fractures." Journal of Neurosurgery: Spine 8, no. 3 (March 2008): 246–54. http://dx.doi.org/10.3171/spi/2008/8/3/246.
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Object Recurrent kyphosis has been commonly seen after posterior short-segment pedicle instrumentation for a thoracolumbar fracture, but studies on this issue are relatively scarce, and the clinical significance of recurrent deformity is uncertain. No study has addressed the associations between the reduction of a burst fracture vertebra and the final recurrent kyphosis after implant removal. The aim of this study was to investigate the recurrent kyphosis after short-segment pedicle screw fixation in thoracolumbar burst fractures and to evaluate the effect of the degree of a vertebral reduction on the recurrent kyphotic deformity after implant removal. Methods Twenty-seven patients who had undergone posterior short-segment pedicle screw fixation for thoracolumbar junction burst fractures (T12–L2) were investigated retrospectively. The minimum follow-up period was 2 years (mean 2.7 years). Pain status was evaluated using the Denis pain scale. Changes in the anterior vertebral height ratio, vertebral wedge angle, upper intervertebral angle, lower intervertebral angle, Cobb angle, regional angle, and sagittal index were measured preoperatively, postoperatively, before implant removal, and at final follow-up. The correlation between the reduction of a fractured vertebra and the recurrent kyphotic deformity was also analyzed. Results After the initial surgical correction, the reduced vertebral body (VB) height (anterior vertebral height ratio and vertebral wedge angle) remained stable until final follow-up, whereas the intervertebral disc space (the upper and lower intervertebral angles) collapsed, resulting in a progressive kyphotic deformity (Cobb angle, regional angle, and sagittal index). No significant correlation was found between the final kyphosis and pain scale, but the 8 patients with a sagittal index > 15° showed a higher incidence of moderate to severe pain (P3–5 on the Denis pain scale) compared with the remaining 19 patients with a sagittal index < 15°. Significant positive correlation was found between recurrent kyphosis and vertebral wedge angle (r = 0.850, p < 0.001) and the reduced vertebral height (r = −0.727, p < 0.001). Conclusions Given that the correction loss occurs primarily through disc space collapse, the amount of the final kyphotic deformity was predictable by the degree of the fractured vertebral reduction as seen on the lateral x-ray study. Surgeons who perform posterior reduction and fixation procedures should pay more attention to reducing the fractured vertebral wedge angle to its intact condition, rather than the segmental angular parameters. If the wedge angle of the fractured VB is unacceptable after reduction, additional reconstruction of the anterior column may be necessary.
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Kim, Hyeun-Sung, and Dong-Hwa Heo. "Percutaneous Pedicle Screw Fixation with Polymethylmethacrylate Augmentation for the Treatment of Thoracolumbar Intravertebral Pseudoarthrosis Associated with Kummell’s Osteonecrosis." BioMed Research International 2016 (2016): 1–7. http://dx.doi.org/10.1155/2016/3878063.
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Purpose. The purpose of our study is to evaluate the therapeutic efficacy of short-segment percutaneous pedicle screw fixation with polymethylmethacrylate (PMMA) augmentation for the treatment of osteoporotic thoracolumbar compression fracture with osteonecrosis.Methods. Osteoporotic thoracolumbar compression fractures with avascular necrosis were treated by short-segment PPF with PMMA augmentation. Eighteen were followed up for more than 2 years. The kyphotic angle, compression ratio, visual analog scale (VAS) score for back pain, and the Oswestry Disability Index (ODI) were analyzed. In addition, radiologic and clinical parameters of PPF group were compared with percutaneous vertebroplasty (PVP) group.Results. Vertebral height and kyphotic angle of the compressed vertebral bodies were significantly corrected after the operation (P<0.05). Further, restored vertebral height was maintained during the 2 or more years of postoperative follow-up. Compared to the PVP group the postoperative compression ratio and kyphotic angle were significantly lower in the PPF group (P<0.05). The postoperative ODI and VAS of the PVP group were significantly higher than the PPF (P<0.05).Conclusions. According to our results, short-segment PPF with PMMA augmentation may be an effective minimally invasive treatment for osteoporosis in cases of osteoporotic vertebral compression fractures with Kummell’s osteonecrosis.
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Chen, Zhongqiang, Yan Zeng, Weishi Li, Zhaoqing Guo, Qiang Qi, and Chuiguo Sun. "Apical segmental resection osteotomy with dual axial rotation corrective technique for severe focal kyphosis of the thoracolumbar spine." Journal of Neurosurgery: Spine 14, no. 1 (January 2011): 106–13. http://dx.doi.org/10.3171/2010.9.spine10257.
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Object In this paper, the authors' goal was to evaluate the feasibility, safety, and efficacy of apical segment resection osteotomy with dual axial rotation correction for severe focal kyphosis by examining outcomes. Methods Between May 2004 and December 2006, the authors treated 23 patients with severe focal kyphosis (average Cobb angle 86.9°, range 50°–130°) using apical segmental resection osteotomy with dual axial rotation correction and instrumented anterior column reconstruction and fusion. Radiographic assessment of sagittal plane balance and kyphotic Cobb angle (including a scoliosis Cobb angle in 9 cases) was performed in each patient before and immediately after surgery and at the last follow-up (minimum 2 years). The Frankel grading system for neurological function and Oswestry Disability Index for quality of life were evaluated before surgery and at the last follow-up. The patient satisfaction index was also used for clinical evaluation at the last follow-up. Results The mean surgical time was 6.7 hours. The average blood loss was 2960 ml. All patients underwent follow-up for 2 or more years after surgery. The fusion rate was 95.65%. The average kyphotic angle improved from 86.9° preoperatively to 25.6° immediately postoperatively, with an average correction rate of 72.17%. At the last follow-up, the average kyphotic angle was 27.4°, making the final correction rate 69.87%. The sagittal plane balance was significantly improved at the last follow-up. Preoperatively, 15 patients had neurological deficits, and the Frankel grade was E in 8 cases, D in 8 cases, C in 6 cases, and B in 1 case. At the last follow-up, 15 cases were Grade E, 5 were Grade D, and 3 were Grade C. The average improvement in the Oswestry Disability Index score was 43.30%. The patient satisfaction index result showed a total satisfaction rate of 91.30%. Complications included 1 case of late neurological deficit due to shifting of an expandable artificial vertebra, 5 cases of nerve root injury, 3 cases of dural tear, and 1 case of transient lower-extremity weakness due to insufficient blood supply to the spinal cord during surgery. Conclusions Apical segmental resection osteotomy with dual axial rotation correction and instrumented fusion is an effective and safe way to treat severe focal kyphosis of the thoracolumbar spine.
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Cheon, Ji Hong, Na Na Lim, Geun Su Lee, Ki Hong Won, Sung Hoon Lee, Eun Young Kang, Hyun Kyung Lee, and Younkyung Cho. "Differences of Spinal Curvature, Thoracic Mobility, and Respiratory Strength Between Chronic Neck Pain Patients and People Without Cervical Pain." Annals of Rehabilitation Medicine 44, no. 1 (February 29, 2020): 58–68. http://dx.doi.org/10.5535/arm.2020.44.1.58.
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Objective To investigate the differences of spinal curvature, thoracic sagittal mobility, and respiratory strength between patients with chronic neck pain (CNP) and people without cervical pain, and to determine the correlation between respiratory strength and thoracic mobility in CNP patients.Methods A total of 78 participants were finally included in this study, of whom 30 had no cervical pain and 48 had CNP. The Neck Disability Index (NDI), cervical lordotic curvature, thoracic kyphotic curvature, thoracic sagittal range of motion (ROM), maximal inspiratory pressure (MIP), and maximal expiratory pressure (MEP) were measured and analyzed.Results In males, thoracic sagittal ROM<sub>MEP-MIP</sub> and MEP showed a significant difference between the no cervical pain group and the CNP group. In females, thoracic kyphotic curvature, thoracic sagittal ROM<sub>MEP-MIP</sub>, MIP, and MEP were significantly different between the no cervical pain group and the CNP group. Thoracic kyphotic curvature was significantly correlated with MEP and MIP in all population groups, and significantly correlated with NDI in the female group. Thoracic sagittal ROM<sub>MEP-MIP</sub> had a significant linear relationship with NDI, MEP, and MIP in all population groups.Conclusion The thoracic mobility during forced respiration was reduced in patients with CNP and was correlated with respiratory strength. Changes in the biomechanics of the cervicothoracic spine and rib cage due to CNP may contribute to impairment of respiratory strength.
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Mo, Ling, Zixian Wu, De Liang, Linqiang Y, Zhuoyan Cai, Jinjing Huang, Shunxin Lin, et al. "Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study." Journal of International Medical Research 49, no. 7 (July 2021): 030006052110222. http://dx.doi.org/10.1177/03000605211022287.
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Objective To evaluate the influence of insufficient bone cement distribution on outcomes following percutaneous vertebroplasty (PVP). Methods This retrospective matched-cohort study included patients 50–90 years of age who had undergone PVP for single level vertebral compression fractures (VCFs) from February 2015 to December 2018. Insufficient (Group A)/sufficient (Group B) distribution of bone cement in the fracture area was assessed from pre- and post-operative computed tomography (CT) images. Assessments were before, 3-days post-procedure, and at the last follow-up visit (≥12 months). Result Of the 270 eligible patients, there were 54 matched pairs. On post-operative day 3 and at the last follow-up visit, significantly greater visual analogue scale (VAS) pain scores and Oswestry Disability Index (ODI) scores were obtained in Group B over Group A, while kyphotic angles (KAs) and vertebral height (VH) loss were significantly larger in Group A compared with Group B. Incidence of asymptomatic cement leakage and re-collapse of cemented vertebrae were also greater in Group A compared with Group B. Conclusions Insufficient cement distribution may relate to less pain relief and result in progressive vertebral collapse and kyphotic deformity post-PVP.
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Pickett, Gwynedd E., Demytra K. Mitsis, Lali H. Sekhon, William R. Sears, and Neil Duggal. "Effects of a cervical disc prosthesis on segmental and cervical spine alignment." Neurosurgical Focus 17, no. 3 (September 2004): 1–35. http://dx.doi.org/10.3171/foc.2004.17.3.5.
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Object Cervical arthroplasty offers the promise of maintaining motion of the functional spinal unit (FSU) after anterior cervical discectomy. The impact of cervical arthroplasty on sagittal alignment of the FSU needs to be addressed, together with its effect on overall sagittal balance of the cervical spine. Methods The authors prospectively reviewed radiographic and clinical outcomes in 14 patients who received the Bryan Cervical Disc prosthesis (Medtronic Sofamor Danek, Memphis, TN), for whom early (< 6 months) and late (6–24 months) follow-up data were available. Static and dynamic radiographs were measured by hand and computer to determine the angles formed by the endplates of the natural disc preoperatively, those formed by the shells of the implanted prosthesis, the angle of the FSU, and the C2–7 Cobb angle. The range of motion (ROM) was also determined radiographically, whereas clinical outcomes were assessed using the Neck Disability Index (NDI), and Short Form–36 (SF-36) questionnaires. The ROM was preserved following surgery, with a mean preoperative sagittal rotation angle of 8.96°, which was not significantly different from the late postoperative value of 8.25°. When compared with the preoperative disc space angle, the shell endplate angle in the neutral position became kyphotic in the early and late postoperative periods (mean change −3.8° in the late follow-up period; p = 0.0035). The FSU angles also became significantly more kyphotic post-operatively, with a mean change of −6° (p = 0.0006). The Cobb angles varied widely preoperatively and did not change significantly after surgery. There was no statistical correlation between the NDI and SF-36 outcomes and cervical kyphosis. Conclusions Cervical arthroplasty preserves motion of the FSU. Both the endplate angle of the treated disc space and the angle of the FSU became kyphotic after insertion of the Bryan prosthesis. The overall sagittal balance of the cervical spine, however, was preserved.
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Nakamae, Toshio, Yoshinori Fujimoto, Kiyotaka Yamada, Takashi Hashimoto, and Kjell Olmarker. "Efficacy of Percutaneous Vertebroplasty in the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft." Open Orthopaedics Journal 9, no. 1 (May 15, 2015): 107–13. http://dx.doi.org/10.2174/1874325001509010107.
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Intravertebral cleft (IVC) is frequently observed in patients with painful osteoporotic vertebral compression fracture (OVCF). Some studies reported the usefulness of percutaneous vertebroplasty (PVP) for treating OVCF with IVC. However, systematic studies are scarce, and their results are conflicting. The purpose of this study was to evaluate the clinical and radiographic results of PVP in the treatment of painful OVCF with IVC. Two hundred ninety-one patients with OVCF with IVC underwent PVP. Back pain was measured using a visual analog scale (VAS), and physical disability was assessed using the Oswestry Disability Index (ODI). Three radiological parameters were assessed: the local kyphotic angle, percentage spinal canal cross-sectional area of compromise, and intravertebral instability of the affected vertebra. The mean follow-up period was 28 months. The mean values for the VAS and ODI were 8.4 and 60.0%, respectively, before PVP, versus 3.9 and 35.4%, respectively, at the final follow-up. The average local kyphotic angle, percentage spinal canal cross-sectional area of compromise, and intravertebral instability were 10.5°, 17.9% and 6.1°, respectively, before PVP and 8.1°, 15.2%, and 0.8°, respectively, at the final follow-up. There were no neurological or systemic complications due to cement leakage. PVP is an effective and safe intervention for treating OVCF with IVC.
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Deng, Zhouming, Hui Zou, Lin Cai, Ansong Ping, Yongzhi Wang, and Qiyong Ai. "The Retrospective Analysis of Posterior Short-Segment Pedicle Instrumentation without Fusion for Thoracolumbar Burst Fracture with Neurological Deficit." Scientific World Journal 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/457634.
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This study aims to investigate the efficacy of posterior short-segment pedicle instrumentation without fusion in curing thoracolumbar burst fracture. All of the 53 patients were treated with short-segment pedicle instrumentation and laminectomy without fusion, and the restoration of retropulsed bone fragments was conducted by a novel custom-designed repositor (RRBF). The mean operation time and blood loss during surgery were analyzed; the radiological index and neurological status were compared before and after the operation. The mean operation time was 93 min (range: 62–110 min) and the mean intraoperative blood loss was 452 mL in all cases. The average canal encroachment was 50.04% and 10.92% prior to the surgery and at last followup, respectively (P<0.01). The preoperative kyphotic angle was 17.2 degree (±6.87 degrees), whereas it decreased to 8.42 degree (±4.99 degrees) at last followup (P<0.01). Besides, the mean vertebral body height increased from 40.15% (±9.40%) before surgery to 72.34% (±12.32%) at last followup (P<0.01). 45 patients showed 1-2 grades improvement in Frankel’s scale at last followup. This technique allows for satisfactory canal clearance and restoration of vertebral body height and kyphotic angle, and it may promote the recovery of neurological function. However, further research is still necessary to confirm the efficacy of this treatment.
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Zeng, Yan, Zhongqiang Chen, Qiang Qi, Zhaoqing Guo, Weishi Li, Chuiguo Sun, and Andrew P. White. "Clinical and radiographic evaluation of posterior surgical correction for the treatment of moderate to severe post-tuberculosis kyphosis in 36 cases with a minimum 2-year follow-up." Journal of Neurosurgery: Spine 16, no. 4 (April 2012): 351–58. http://dx.doi.org/10.3171/2011.12.spine11568.
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Object The object of this study was to compare the clinical and radiographic outcomes of 36 patients with posttuberculosis kyphosis who underwent one of two types of osteotomy. Methods Each patient underwent single-stage correction via a posterior surgical approach. A modified pedicle subtraction osteotomy (mPSO) was performed when the kyphotic deformity was less than 70° (7 cases), whereas a posterior vertebral column resection (VCR) was performed when the kyphotic deformity exceeded 70° (29 cases). Full-length standing radiographs were obtained before surgery and at follow-up visits. These images were used to measure the kyphosis angle; sagittal alignment of the lumbar, thoracic, and cervical regions; and sagittal balance of the spine. Back pain was rated using the visual analog scale (VAS), and neurological function was classified based on the American Spinal Injury Association (ASIA) grading system. Each patient's overall satisfaction with surgical treatment was measured with the Patient Satisfaction Index. For purposes of comparison, patients were studied in 2 groups based on the region of their kyphotic apex. Half of the cohort had apical kyphosis in the lower thoracic spine or thoracolumbar junction (TL group). Using both radiographic and clinical assessments, the authors compared this group with the other half of the patients who had apical kyphosis in the upper to mid thoracic spine (MT group). Results The cohort included 15 males and 21 females, with an average age of 34 years at the time of surgery. The minimum follow-up was 24 months, and the mean follow-up was 31 months. Following surgery, kyphosis across the treated segments was reduced by an average of 60°. Lumbar lordosis also improved by an average of 24°, and thoracic kyphosis improved by an average of 20°. Both back pain and neurological function improved after surgical treatment. There was a 67% improvement in VAS scores, and 13 of the 36 patients had improvement in their ASIA grade. The 2 surgical procedures used for deformity correction (mPSO and VCR) demonstrated comparable radiographic and clinical results. Note, however, that differences were found in both radiographic and clinical outcomes in comparing patients who had lower thoracic or thoracolumbar (TL group) versus upper to midthoracic (MT group) apical kyphosis. Conclusions Posterior tubercular kyphosis can be effectively improved through corrective surgery, and deformity correction can be accompanied by improvement in clinical symptoms. When appropriately selected, both the mPSO and the VCR can be expected to yield satisfactory reduction of post-tuberculosis kyphotic deformities. Differences in radiographic and clinical outcomes should be anticipated, however, when treating such deformities in different regions of the spine.
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Nishiwaki, Y., T. Michikawa, N. Eto, and T. Takebayashi. "Body Mass Index Misclassification Due to Kyphotic Posture in Japanese Community-Dwelling Adults Aged 65 Years and Older." Journals of Gerontology Series A: Biological Sciences and Medical Sciences 66A, no. 3 (February 7, 2011): 326–31. http://dx.doi.org/10.1093/gerona/glq227.
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Pieterse, Simone, Mary Manandhar, and Suraiya Ismail. "The nutritional status of older Rwandan refugees." Public Health Nutrition 1, no. 4 (December 1998): 259–64. http://dx.doi.org/10.1079/phn19980042.
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AbstractObjective:To assess the nutritional status of older people in an unstable situation.Design:Anthropometric and socioeconomic data were collected cross-sectionally. Body mass index (BMI), arm muscle area (AMA) and arm fat area (AFA) were calculated to evaluate nutritional status. For 41 subjects with kyphosis, height was estimated from arm span using sex-specific regression equations from the non-kyphotic group.Setting:The study was carried out in the post-emergency phase in a Rwandan refugee camp in Karagwe district, north-west Tanzania.Subjects:Measurements were obtained from 413 men and 415 women aged 50–92 years.Results:The prevalence of undernutrition (BMI < 18.5) was 19.5% in men and 13.1% in women and was higher above age 60 years in both sexes: in men the prevalences were 23.2% and 15.0% (P < 0.05) and in women 15.1% and 10.9% for the older and younger age groups respectively. AMA, which is important in relation to the ability to remain active and independent, was also significantly lower in older age groups. No difference was found in AFA. The proportion with low BMI was much higher in the group with kyphosis.Conclusions:Even in this population of older Rwandans who managed to reach the camp and survive in exile for more than a year, undernutrition does occur and is more prevalent at an advanced age. The higher prevalence of undernutrition in kyphotic people illustrates the importance of including this group in nutritional status assessments.
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Ptashnikov, D. A., S. S. Magomedov, S. P. Rominskiy, and P. G. Mytyga. "Assessment of new method of posterior spinal fusion in the treatment of patients with posttraumatic kyphotic deformity of the thoracic and lumbar spine." Hirurgiâ pozvonočnika (Spine Surgery) 18, no. 3 (September 15, 2021): 30–35. http://dx.doi.org/10.14531/ss2021.3.30-35.
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Objective. To carry out a comparative analysis of two methods of the posterior bone block formation (with autograft bone chips or with a whole vertebral arch) and to assess the rate of bone block formation, the degree of surgery invasiveness and the patient-reported cosmetic satisfaction with the results.Material and Methods. The study involved 31 patients with kyphotic deformity of the thoracic spine, of which 15 patients underwent spinal fusion using autograft bone chips (control group), and 16 were operated on using a new technique with a whole vertebral arch. The results of treatment were assessed using a modified MacNab scale. During the follow-up period from 1.5 to 2 years, pain syndrome was assessed according to VAS, quality of life according the Oswestry Disability Index, and cosmetic satisfaction was assessed using the SRS-22 scale.Results. In the course of the work, it was revealed that in patients who were operated on using new method, the time of bone block formation according to CT data was shorter, the overall satisfaction with surgery result was higher (mainly due to the absence of a cosmetic defect), and the indicators of the operation duration and blood loss did not differ compared to those in the control group.Conclusion. Based on the results obtained, spinal fusion using a whole vertebral arch can be recommended in clinical practice for surgical interventions in patients with kyphotic deformities of the spine.
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Ahsan, Md Kamrul, Zabed Zahangiri, M. A. Awwal, Naznin Zaman, Md Hamidul Haque, and Abdullah Al Mahmud. "Posterior fixation including the fractured vertebra in short segment fixation of unstable thoracolumbar junction burst fractures." Bangabandhu Sheikh Mujib Medical University Journal 9, no. 2 (August 17, 2016): 81. http://dx.doi.org/10.3329/bsmmuj.v9i2.29046.
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<p>The aim of this study was to evaluate the efficacy of inclusion of the fractured vertebra in short segment fixation in terms of clinical and the radiological outcomes in unstable thoracolumbar junction burst fractures at a minimum of 1 year follow-up. Records of 52 patients (age: 21-50 years) with thoracolumbar burst fracture (T10–L2) in Magerl Type A fractures underwent posterior pedicle screw fixation including the fractured vertebra. Clinical parameters were back pain using Visual Analogue Score (VAS) and disability using Oswestry disability index (ODI), neurological deficit (using ASIA grade) and radiologic parameters (Cobb angle, the kyphotic deformation and vertebral height) were measured before surgery and at 3, 6 and 12 months post-operatively. The presence of screw breakage, screw pullout, peri-implant loosening, and rod breakage were considered as criteria for implant failure. The majority of fractures resulted due to falls (31 cases), and the remaining cases resulted from car accidents (21 cases). The fractured vertebral body level was L1, T12, L2, T11, and T10 in 23, 17, 6, 4 and 2 cases and achieved satisfactory clinical outcomes according to the modified Mcnab criteria 18, 25, 6 and 3 cases were considered to have excellent, good, fair, and poor outcome. The mean kyphotic angle at pre-, post-operative and final follow-up was 13.5 ± 6.3, 13.4 ± 4.3, 8.5 ± 6. The average loss of kyphosis correction was 6.4 ± 5.2° at the final follow-up. The mean pre- and post-operative kyphotic deformation of vertebral body was 5.1 ± 3.2, 4.8 ± 2.3 and at final follow-up was 4.5 ± 4.0 (p>0.05). The mean anterior and posterior vertebral height also showed significant improvements post-operatively, which were maintained at the final follow-up. The mean ODI and VAS scores at the end of 1 year were 17.4%, 1.7 respectively. There was no case of major complication after surgery and during the follow-up period. In conclusion, reduction of unstable thoracolumbar junction burst fracture can be achieved and maintained with the use of short-segment pedicle screw fixation including the fractured vertebra, avoiding the need for anterior reconstruction.</p><p> </p>
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Qin, Rongqing, Xing Zhang, Hongpeng Liu, Bing Zhou, Pin Zhou, and Chuanliang Hu. "Application of Anchoring Technique in Unilateral Percutaneous Vertebroplasty for Neurologically Intact Kümmell’s Disease." Pain Research and Management 2020 (May 25, 2020): 1–7. http://dx.doi.org/10.1155/2020/4145096.
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Purpose. We aimed to present our experience in anchoring technique and evaluate the efficacy and safety of unilateral percutaneous vertebroplasty in patients with neurologically intact Kümmell’s disease. Methods. From January 2014 to December 2017, 29 patients (17 males and 12 females) with neurologically intact Kümmell’s disease were operated on using anchoring technique in unilateral percutaneous vertebroplasty (PVP). Ages of the enrolled patients ranged from 67 to 81 years (mean 73.8 years). Clinical efficacy was evaluated by back pain visual analogue scale (BP-VAS) score, Oswestry disability index (ODI) score, as well as the height of anterior border and the kyphotic angle of the involved vertebral body on a standing lateral radiograph. The safety of PVP was assessed by surgical-related complications, including bone cement leakage and neurological deficit. Results. All 29 patients underwent the PVP procedure successfully. The mean operation time was 35 ± 12 min. And all patients were able to walk/ambulate with a thoracolumbar brace after 12 to 24 hours, staying in bed postoperatively. Significantly statistical differences were observed in both BP-VAS and ODI scores at each time point of follow-up when compared with the preoperative condition (P<0.05). Besides, statistically significant improvement in radiographic measurements such as kyphotic angle and the height of the anterior border of the involved vertebral body between the preoperative and postoperative assessments was also observed (P<0.05) and asymptomatic leakage of cement occurred in 7 of 29 cases (24.1%). Conclusions. We considered that the anchoring technique in unilateral PVP could provide an effective and safe alternative for neurologically intact Kümmell’s disease.
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Niu, Junjie, Dawei Song, Minfeng Gan, Bin Liu, Chenglong Tan, Huilin Yang, and Bin Meng. "Percutaneous kyphoplasty for the treatment of distal lumbosacral pain caused by osteoporotic thoracolumbar vertebral fracture." Acta Radiologica 59, no. 11 (February 26, 2018): 1351–57. http://dx.doi.org/10.1177/0284185118761204.
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Background Kyphoplasty has been demonstrated to be minimally invasive and effective in treating osteoporotic vertebral fracture patients with back pain over the level of the fractured vertebrae. Rare studies have reported on thoracolumbar vertebral fracture patients presenting with distal lumbosacral pain (DLP). Whether kyphoplasty had a favorable therapeutic benefit for these patients remains unclear. Purpose To evaluate the therapeutic efficacy of kyphoplasty in treating osteoporotic thoracolumbar vertebral fracture (OTVF) patients with DLP and assess the clinical significance of focal tenderness to palpation in these patients. Material and Methods Thirty-two OTVF patients who only complained of DLP were treated by kyphoplasty. The vertebral heights, local kyphotic angle, Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI) scores were assessed preoperatively, one day after surgery, and at last follow-up. All patients were evaluated regarding their degree of satisfaction with kyphoplasty. In addition, we compared the therapeutic efficacy of kyphoplasty in patients with and without focal tenderness to palpation. Results All patients successfully underwent kyphoplasty without complications. The vertebral heights, local kyphotic angles, VAS, and ODI scores were all significantly improved after kyphoplasty and maintained at last follow-up in our patients ( P < 0.001). At last follow-up, all patients expressed satisfaction with kyphoplasty. No significant differences in these parameters were detected between patients with and without focal tenderness. Conclusion The possibility of thoracolumbar vertebral fractures in elderly patients complaining of DLP should not be neglected. Kyphoplasty presents a superior benefit in treating OTVF patients with DLP. The absence of focal tenderness does not influence the clinical efficacy in these patients.
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Shin, Hun Kyu, Jai Hyung Park, In Gyu Lee, Jin Hun Park, Jun Hyoung Park, and Yongun Cho. "A study on the relationship between the rate of vertebral body height loss before balloon kyphoplasty and early adjacent vertebral fracture." Journal of Back and Musculoskeletal Rehabilitation 34, no. 4 (July 13, 2021): 649–56. http://dx.doi.org/10.3233/bmr-200121.
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BACKGROUND: The number of patients with an osteoporotic vertebral compression fracture, which is often accompanied by lower back pain and restrained activities, is growing. Balloon kyphoplasty involves the inflation of a balloon to restore height and reduce kyphotic deformity before stabilization with polymethylmethacrylate. However, there is a great deal of debate about whether balloon kyphoplasty also increases fracture morbidity by either inducing or facilitating subsequent adjacent vertebral fractures. OBJECTIVE: To evaluate the relationship between the rate of vertebral body height loss before balloon kyphoplasty and the etiology of early adjacent vertebral fracture after augmentation. METHODS: A total of 59 patients with osteoporotic vertebral compression fractures who underwent kyphoplasty were enrolled. This study defined early adjacent segmental fractures as new fractures occurring within three months after surgery. This study included the rate of vertebral body height loss. RESULTS: Early adjacent vertebral fractures were diagnosed in nine (15%) of the 59 patients. The patients were divided into two groups, with and without adjacent vertebral fractures. There was no significant difference in terms of age, body mass index, bone mineral density, local kyphotic angle, Cobb’s angle, cement volume, cement leakage, and percent height restored between the groups with fractures and without fractures. There was a statistically significant difference between the two groups in the rate of vertebral body height loss. The rate of vertebral body height loss was significantly higher in the fracture group than in the without fracture group. CONCLUSIONS: A high rate of vertebral body height loss increased the risk of early adjacent vertebral fractures after balloon kyphoplasty.
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Singh, Suryakant, Hitesh Dawar, Kalidutta Das, Bibhudendu Mohapatra, and Somya Prasad. "Functional and Radiological Outcomes of Anterior Decompression and Posterior Stabilization via Posterior Transpedicular Approach in Thoracic and Thoracolumbar Pott's Disease: A Retrospective Study." Asian Spine Journal 11, no. 4 (August 31, 2017): 618–26. http://dx.doi.org/10.4184/asj.2017.11.4.618.
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<sec><title>Study Design</title><p>This is a retrospective study.</p></sec><sec><title>Purpose</title><p>To determine the efficacy and safety of a posterior transpedicular approach with regard to functional and radiological outcomes in people with thoracic and thoracolumbar spinal tuberculosis.</p></sec><sec><title>Overview of Literature</title><p>Spinal tuberculosis can cause serious morbidity, including permanent neurological deficits and severe deformities. Medical treatment or a combination of medical and surgical strategies can control the disease in most patients, thereby decreasing morbidity incidence. A debate always existed regarding whether to achieve both decompression and stabilization via a combined anterior and posterior approach or a single posterior approach exists.</p></sec><sec><title>Methods</title><p>The study was conducted at the Indian Spinal injuries Centre and included all patients with thoracic and thoracolumbar Pott's disease who were operated via a Posterior transpedicular approach. Data regarding 60 patients were analyzed with respect to the average operation time, preoperative and postoperative, 6 months and final follow-up American Spinal Injury Association (ASIA) grading, bony fusion, implant loosening, implant failure, preoperative, postoperative, 6 months and final follow-up kyphotic angles, a loss of kyphotic correction, Oswestry disability index (ODI) score, and visual analog scale (VAS) score. Data were analyzed using either a paired t -test or a Wilcoxon Signed Rank test.</p></sec><sec><title>Results</title><p>The mean operation time was 260±30 minutes. Fifty-five patients presented with evidence of successful bony fusion within a mean period of 6±1.5 months. Preoperative dorsal and lumbar angles were significantly larger than postoperative angles, which were smaller than final follow-up angles. The mean kyphotic correction achieved was 12.11±14.8, with a mean decrease of 5.97 and 19.1 in VAS and ODI scores, respectively.</p></sec><sec><title>Conclusions</title><p>Anterior decompression and posterior stabilization via a posterior transpedicular approach are safe and effective procedures, with less intraoperative surgical duration and significant improvements in clinical and functional status.</p></sec>
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Eleraky, Mohammed, Ioannis Papanastassiou, Matthias Setzer, Ali A. Baaj, Nam D. Tran, and Frank D. Vrionis. "Balloon kyphoplasty in the treatment of metastatic tumors of the upper thoracic spine." Journal of Neurosurgery: Spine 14, no. 3 (March 2011): 372–76. http://dx.doi.org/10.3171/2010.11.spine09909.
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Object Balloon kyphoplasty has recently been shown to be effective in providing rapid pain relief and enhancing health-related quality of life in patients with metastatic spinal tumors. When performed to treat lesions of the upper thoracic spine, kyphoplasty poses certain technical challenges because of the smaller size of the pedicle and vertebral bodies. Fluoroscopic visualization is also difficult due to interference of the shoulder. The authors' objective in the present study was to evaluate their approach and the results of balloon kyphoplasty in the upper thoracic spine in patients with metastatic spinal disease. Methods Fourteen patients underwent kyphoplasty via an extrapedicular approach to treat metastatic tumors in the upper (T1–5) thoracic spine. Electrodiagnostic monitoring (somatosensory and motor evoked potentials) was used in 5 cases. Three levels were treated in 7 cases, 2 levels in 2 cases, and 1 level in 5 cases. In 3 cases access was bilateral, whereas in 11 cases access was unilateral. The procedure took an average of 25 minutes per treated level, and the mean amount of cement applied was 3 ml per level. Four patients were discharged from the hospital on the day of the procedure, and 10 patients went home after 24 hours. Results All patients exhibited marked improvement in mean visual analog scale scores (preoperative score 79 vs postoperative score 30, respectively) and Oswestry Disability Index scores (83 vs 33, respectively). The mean kyphotic angle was 25.03° preoperatively, whereas the mean postoperative angle was 22.65° (p > 0.3). At latest follow-up, the mean kyphotic angle did not differ significantly from the postoperative kyphotic angle (26.3°, p > 0.1). No neurological deficits or lung-related complications (pneumothorax or hemothorax) were encountered in any of the patients. Polymethylmethacrylate cement extravasations were observed in 3 (10%) of 30 treated vertebral bodies without any sequelae. By a mean follow-up of 16 months, no patients had experienced an adjacent-level fracture. Conclusions Balloon kyphoplasty of the upper thoracic spine via an extrapedicular approach is an efficient and safe minimally invasive procedure that may provide immediate and long-term pain relief and improvement in functional ability. It is technically challenging and has the potential for serious complications. With a fundamental knowledge of anatomy, as well as an ability to interpret fluoroscopy images, one can feasibly and safely perform balloon kyphoplasty in the upper thoracic spine.
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De Brito, Marcelo Botelho Soares, João Paulo Machado Bergamaschi, Luciano Antonio Nassar Pellegrino, Ricardo Shigueaki Galhego Umeta, Maria Fernanda Silber Caffaro, Robert Meves, and Osmar Avanzi. "Kyphosis in fractures: evaluation of digital measuring." Coluna/Columna 13, no. 2 (2014): 133–35. http://dx.doi.org/10.1590/s1808-18512014130200322.
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Objective: This study evaluates the manual and digital reliability and reproducibility of five methods of measuring deformity (kyphosis) in thoracolumbar burst fractures. Method: Ninety (90) tomographic images were evaluated and, in each case, kyphotic deformity was measured, both manually and digitally, through the five most relevant methods described in the literature. For the assessment of intraobserver error, 20 cases were measured again. Results: The results show that all five methods are highly reliable and digitally reproducible, with estimated error near or lower than that indicated in the intraobserver error analysis. Cobb's method had the highest concordance (96%) while the sagittal index had the lowest concordance (75%). It is also suggested that digital assessment is more reliable then the manual method. Conclusion: All tested methods are highly reliable and digitally reproducible.
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Islam, Md Anowarul, Manish Shrestha, Santosh Batajoo, Dipendra Mishra, and Khandaker Hafijur Rahman. "Percutaneous balloon kyphoplasty, a good minimally invasive surgical option for osteoporotic thoracolumbar compression fracture." Bangabandhu Sheikh Mujib Medical University Journal 11, no. 2 (May 30, 2018): 199. http://dx.doi.org/10.3329/bsmmuj.v11i2.36627.
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<p>The aim of this study is to evaluate balloon kyphoplasty as a surgical option for osteoporotic thoracolumbar compression fracture. The study was conducted on 30 patients from January 2014 to December 2017. The anterior vertebral height, kyphotic angle and functional evaluation by Oswestry disability index (ODI) and visual analogue scale (VAS) score were recorded preoperatively, immediate post-operatively at 3, 6, 12 months and yearly then on. All patients showed improvement in mean kyphotic angle from 16.4 ± 3.5 to 5.6 ± 1.7 post-operatively and 8.4 ± 1.6 at final follow-up. There was significant increase in mean anterior vertebral height from 51 ± 7.3% before surgery to 75.5 ± 7.4% at one day after surgery and 71.2 ± 3.2% at the last follow-up. There was significant improvement in mean VAS score from 8.1 ± 0.9 before surgery to 2.2 ± 0.4 at one day, and 2.4 ± 0.3 at final follow-up. The improvement in patients’ ODI score after surgery from 71.4 ± 3.4 to 26.0 ± 4.8 at one day and 21.2 ± 5.5 at final follow-up was noted. The mean operating time was 45.5 ± 15.5 min for each vertebra. Within first day of surgery improvement in pain relief and mobility was experienced by all patients. The orthopedic balloon ruptured in one patient and it was replaced then procedure was continued with no complications. There were no neurological complications in all cases and there was no infections and any occurrence of symptomatic pulmonary embolism. In conclusion, balloon kyphoplasty is a good minimally invasive procedure where along with reduction of pain and disability there is also restoration of sagittal alignment post-operatively.</p>
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Kapo, Safet, Izet Rađo, Nusret Smajlović, Siniša Kovač, Munir Talović, Ivor Doder, and Nedim Čović. "Increasing postural deformity trends and body mass index analysis in school-age children." Slovenian Journal of Public Health 57, no. 1 (January 5, 2018): 25–32. http://dx.doi.org/10.2478/sjph-2018-0004.
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Abstract Introduction The aim of the study was to analyse the deviations of the body posture and to assess the occurrence of spine deformities. Additionally, Body Mass Index in school children was related to the trend in postural deformities for different age groups (5-8 years old, n=112; 9-11 years old, n=205; 12-14 years old, n=212) as part of the project “Spine Lab”, granted from the European Commission IPA founds, investigating the importance of public health issues. Methods Body posture was measured using Contemplas 3D software analyser, based on video image trajectory and BIA weight scale (Tanita BC 420). Overall, 17 variables were assessed, and differences were confirmed using MANOVA analysis. Results The results showed that there is a significant difference between age groups for the measured variables (F=9.27; p<0.01; η2=0.26), suggesting a moderate difference across the age span. Conclusion The study results showed that there is a negative trend of increasing Body Mass Index within the first and youngest age group. The fact is that the trend of increasing deformity of the shoulder belt has been noted, often inclining towards the formation of milder forms of kyphotic posture. Other forms of deformity that are accentuated in the survey results are the negative trend of increasing pelvic rotation and pelvis rotation which inclines towards the formation of lordotic posture for all three age groups.
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Likhachev, S. V., V. V. Zaretskov, V. B. Arsenievich, V. V. Ostrovskij, A. E. Shulga, and A. V. Zaretskov. "Outcomes with fracture-level transpedicular screws used for thoracolumbar junction fractures." Genij Ortopedii 26, no. 4 (December 2020): 548–54. http://dx.doi.org/10.18019/1028-4427-2020-26-4-548-554.
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Background Short-segment transpedicular screw fixation (SSTSF) is the preferred treatment option for thoracolumbar burst fractures. Adding screws in the fractured body may be helpful in achieving and maintaining fracture reduction. However, the operative approach is disputed. Objective To compare clinical outcomes of transpedicular fixation with and without screws in the fractured vertebral body after isolated uncomplicated fractures at the thoracolumbar junction. Material and methods A retrospective cohort study enrolled 62 patients with Th11–L2 thoracolumbar burst fractures (AOSpine A3, A4) who underwent SSTSF with (n = 32) and without (n = 30) pedicle screws at the fracture level. Demographic data of the patients, operating time and blood loss were registered. Clinical evaluation using Visual analogue scale (VAS ) for pain, Oswestry Disability Index (ODI) to quantify disability and imaging parameters of segmental kyphosis, loss of correction, anterior vertebral body height (AVBH) at the fracture level, spinal canal stenosis (SCS) were measured preoperatively, at one week, 1 month, 6 and 12 months postoperatively. Results The patients of the two groups showed no statistically significant differences in the demographic data, VAS and ODI scores, measurements of kyphotic angle, AVBH, SCS preoperatively (p > 0.05). Screws at the fracture level did not affect the operating time and intraoperative blood loss relative to conventional no-screw group. Benefits with fracture screws were evident at 7 days (p < 0.01) measuring SCS, at 6 months (p < 0.01) and 12 (p < 0.01) months measuring kyphotic angle. There was better kyphosis correction (p < 0.01) and AVBH (p = 0.034) seen at 12 months after surgery. Conclusion Reinforcement of a broken vertebra with fracture-level screws has been shown to provide better stability of clinical and radiographic results as compared to those with conventional SSTSF.
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Buell, Thomas J., Ulas Yener, Tony R. Wang, Avery L. Buchholz, Chun-Po Yen, Mark E. Shaffrey, Christopher I. Shaffrey, and Justin S. Smith. "Sacral insufficiency fractures after lumbosacral arthrodesis: salvage lumbopelvic fixation and a proposed management algorithm." Journal of Neurosurgery: Spine 33, no. 2 (August 2020): 225–36. http://dx.doi.org/10.3171/2019.12.spine191148.
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OBJECTIVESacral insufficiency fracture after lumbosacral (LS) arthrodesis is an uncommon complication. The objective of this study was to report the authors’ operative experience managing this complication, review pertinent literature, and propose a treatment algorithm.METHODSThe authors analyzed consecutive adult patients treated at their institution from 2009 to 2018. Patients who underwent surgery for sacral insufficiency fractures after posterior instrumented LS arthrodesis were included. PubMed was queried to identify relevant articles detailing management of this complication.RESULTSNine patients with a minimum 6-month follow-up were included (mean age 73 ± 6 years, BMI 30 ± 6 kg/m2, 56% women, mean follow-up 35 months, range 8–96 months). Six patients had osteopenia/osteoporosis (mean dual energy x-ray absorptiometry hip T-score −1.6 ± 0.5) and 3 received treatment. Index LS arthrodesis was performed for spinal stenosis (n = 6), proximal junctional kyphosis (n = 2), degenerative scoliosis (n = 1), and high-grade spondylolisthesis (n = 1). Presenting symptoms of back/leg pain (n = 9) or lower extremity weakness (n = 3) most commonly occurred within 4 weeks of index LS arthrodesis, which prompted CT for fracture diagnosis at a mean of 6 weeks postoperatively. All sacral fractures were adjacent or involved S1 screws and traversed the spinal canal (Denis zone III). H-, U-, or T-type sacral fracture morphology was identified in 7 patients. Most fractures (n = 8) were Roy-Camille type II (anterior displacement with kyphosis). All patients underwent lumbopelvic fixation via a posterior-only approach; mean operative duration and blood loss were 3.3 hours and 850 ml, respectively. Bilateral dual iliac screws were utilized in 8 patients. Back/leg pain and weakness improved postoperatively. Mean sacral fracture anterolisthesis and kyphotic angulation improved (from 8 mm/11° to 4 mm/5°, respectively) and all fractures were healed on radiographic follow-up (mean duration 29 months, range 8–90 months). Two patients underwent revision for rod fractures at 1 and 2 years postoperatively. A literature review found 17 studies describing 87 cases; potential risk factors were osteoporosis, longer fusions, high pelvic incidence (PI), and postoperative PI-to–lumbar lordosis (LL) mismatch.CONCLUSIONSA high index of suspicion is needed to diagnose sacral insufficiency fracture after LS arthrodesis. A trial of conservative management is reasonable for select patients; potential surgical indications include refractory pain, neurological deficit, fracture nonunion with anterolisthesis or kyphotic angulation, L5–S1 pseudarthrosis, and spinopelvic malalignment. Lumbopelvic fixation with iliac screws may be effective salvage treatment to allow fracture healing and symptom improvement. High-risk patients may benefit from prophylactic lumbopelvic fixation at the time of index LS arthrodesis.
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Snowden, Ryan, Justin Miller, Tome Saidon, Joseph D. Smucker, K. Daniel Riew, and Rick Sasso. "Does index level sagittal alignment determine adjacent level disc height loss?" Journal of Neurosurgery: Spine 31, no. 4 (October 2019): 579–86. http://dx.doi.org/10.3171/2019.4.spine181468.
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OBJECTIVEThe authors sought to compare the effect of index level sagittal alignment on cephalad radiographic adjacent segment pathology (RASP) in patients undergoing cervical total disc arthroplasty (TDA) or anterior cervical discectomy and fusion (ACDF).METHODSThis was a retrospective study of prospectively collected radiographic data from 79 patients who underwent TDA or ACDF and were enrolled and followed prospectively at two centers in a multicenter FDA investigational device exemption trial of the Bryan cervical disc prosthesis used for arthroplasty. Neutral lateral radiographs were obtained pre- and postoperatively and at 1, 2, 4, and up to 7 years following surgery. The index level Cobb angle was measured both pre- and postoperatively. Cephalad disc degeneration was determined by a previously described measurement of the disc height/anteroposterior (AP) distance ratio.RESULTSSixty-eight patients (n = 33 ACDF; n = 35 TDA) had complete radiographs and were included for analysis. Preoperatively, there was no difference in the index level Cobb angle between the ACDF and TDA patients. Postoperatively, the ACDF patients had a larger segment lordosis compared to the TDA patients (p = 0.002). Patients who had a postoperative kyphotic Cobb angle were more likely to have undergone TDA (p = 0.01). A significant decrease in the disc height/AP distance ratio occurred over time (p = 0.035), by an average of 0.01818 at 84 months. However, this decrease was not influenced by preoperative alignment, postoperative alignment, or type of surgery.CONCLUSIONSIn this cohort of patients undergoing TDA and ACDF, the authors found that preoperative and postoperative sagittal alignment have no effect on RASP at follow-up of at least 7 years. They identified time as the only significant factor affecting RASP.
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Lee, Su Hun, Dong Wuk Son, Jun Jae Shin, Yoon Ha, Geun Sung Song, Jun Seok Lee, and Sang Weon Lee. "Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty." Journal of Korean Neurosurgical Society 64, no. 5 (September 1, 2021): 677–92. http://dx.doi.org/10.3340/jkns.2020.0294.
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Many studies have focused on pre-operative sagittal alignment parameters which could predict poor clinical or radiological outcomes after laminoplasty. However, the influx of too many new factors causes confusion. This study reviewed sagittal alignment parameters, predictive of clinical or radiological outcomes, in the literature. Preoperative kyphotic alignment was initially proposed as a predictor of clinical outcomes. The clinical significance of the K-line and K-line variants also has been studied. Sagittal vertical axis, T1 slope (T1s), T1s-cervical lordosis (CL), anterolisthesis, local kyphosis, the longitudinal distance index, and range of motion were proposed to have relationships with clinical outcomes. The relationship between loss of cervical lordosis (LCL) and T1s has been widely studied, but controversy remains. Extension function, the ratio of CL to T1s (CL/T1s), and Sharma classification were recently proposed as LCL predictors. In predicting postoperative kyphosis, T1s cannot predict postoperative kyphosis, but a low CL/T1s ratio was associated with postoperative kyphosis.
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Wang, Tianhao, Yongfei Zhao, Yan Liang, Haocong Zhang, Zheng Wang, and Yan Wang. "Risk factor analysis of proximal junctional kyphosis after posterior osteotomy in patients with ankylosing spondylitis." Journal of Neurosurgery: Spine 29, no. 1 (July 2018): 75–80. http://dx.doi.org/10.3171/2017.11.spine17228.
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OBJECTIVEThe aim of this paper was to analyze the incidence and risk factors of proximal junctional kyphosis (PJK) in patients with ankylosing spondylitis (AS) who underwent pedicle subtraction osteotomy.METHODSThe records of 83 patients with AS and thoracolumbar kyphosis who underwent surgery at the authors’ institution between 2007 and 2013 were reviewed. The patients were divided into 2 groups based on the presence or absence of PJK. The radiographic measurements, including proximal junctional angle (PJA), sagittal parameters, and pelvic parameters of these 2 groups, were compared at different time points: before surgery and 2 weeks, 12 months, and 2 years after surgery. Oswestry Disability Index scores were also evaluated.RESULTSOverall, 14.5% of patients developed PJK. Before surgery, the mean PJAs in the 2 groups were 13.6° and 8.5°, respectively (p = 0.008). There were no significant differences in age, sex, and body mass index between groups. Patients with PJK had a larger thoracolumbar kyphotic angle (50.8° ± 12.6°) and a greater sagittal vertical axis (21.7 ± 4.3 cm) preoperatively than those without PJK. The proportion of patients with PJK whose fusion extended to the sacrum was 41.2% (7/17), which is significantly greater than the proportion of patients with PJK whose lowest instrumented vertebra was above the sacrum. Oswestry Disability Index scores did not significantly increase in the PJK group compared with the non-PJK group.CONCLUSIONSThe authors found that PJK occurs postoperatively in patients with AS with an incidence of 14.5%. Risk factors of PJK include larger preoperative sagittal vertical axis, PJA, and osteotomy angle. Reducing the osteotomy angle in some severe cases and extending fusion to a higher, flatter level would be also beneficial in decreasing the risk of PJK.
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Self, Mitchell, James Mooney, John Amburgy, Bonita Agee, Leah Schoel, Patrick Pritchard, and Melissa Chambers. "Analysis of injected cement volume and clinical outcomes following kyphoplasty for vertebral compression fractures." Surgical Neurology International 11 (March 28, 2020): 56. http://dx.doi.org/10.25259/sni_22_2020.
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Background: It has been suggested that greater volumes of cement injected during kyphoplasty correlate with improved vertebral body height restoration and kyphotic angulation correction. However, there is little evidence tying cement volume to patient outcomes. Here, we analyzed the association between cement volume and outcome utilizing indices of pain, disability, and quality of life. Methods: One hundred and thirty-six patients undergoing kyphoplasty were analyzed retrospectively. The total volume of bone cement injected was recorded intraoperatively for each patient; the average total cement volume was 5.44 cc. Pre- and postoperative outcome indices were documented, using the visual analog scale (VAS), Roland-Morris disability index (RMDI), and the EuroQol 5 Dimension instrument (EQ5D). Pearson’s correlations and linear regression models were derived for the association of total cement volume with each of the patient outcome measures. This was a retrospective cohort study. Results: The average change in VAS, RMDI, and EQ5D scores for all patients was −6.8, +8.3, and +0.41, respectively. For VAS, RMDI, and EQ5D improvements, neither Pearson’s correlations nor multiple linear regression models revealed a correlation or an association with total cement volume. Conclusion: For patients undergoing kyphoplasty, outcomes were not associated with the total injected cement volume; all had a significant reduction in pain and most exhibited decreased disability with improved quality of life.
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Wu, Meng-Huang, Navneet Kumar Dubey, Ching-Yu Lee, Yen-Yao Li, Chin-Chang Cheng, Chung-Sheng Shi, and Tsung-Jen Huang. "Application of Intraoperative CT-Guided Navigation in Simultaneous Minimally Invasive Anterior and Posterior Surgery for Infectious Spondylitis." BioMed Research International 2017 (2017): 1–7. http://dx.doi.org/10.1155/2017/2302395.
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This study was aimed at evaluating the safety and efficacy of using intraoperative computed tomography- (iCT-) guided navigation in simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. Nine patients with infectious spondylitis were enrolled in this study. The average operative time was 327.6 min (range, 210–490) and intraoperative blood loss was 407 cc (range, 50–1,200). The average duration of hospital stay was 48.9 days (range, 11–76). Out of a total of 54 pedicle screws employed, 53 screws (98.1%) were placed accurately. A reduced visual analog scale on back pain (from 8.2 to 2.2) and Oswestry disability index (from 67.1% to 25.6%) were found at the 2-year follow-up. All patients had achieved resolution of spinal infection with reduced average erythrocyte sedimentation rate (from 83.9 to 14.1 mm/hr) and average C-reactive protein (from 54.4 to 4.8 mg/dL). Average kyphotic angle correction was 10.5° (range, 8.4°–12.6°) postoperatively and 8.5° (range, 6.9°–10.1°) after 2 years. In conclusion, the current iCT-guided navigation approach has been demonstrated to be an alternative method during simultaneous minimally invasive anterior and posterior surgery for infectious spondylitis. It can provide a good intraoperative orientation and visualization of anatomic structures and also a high pedicle screw placement accuracy in patient’s lateral decubitus position.
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Noriega, David, Gianluca Maestretti, Christian Renaud, Natale Francaviglia, Mourad Ould-Slimane, Steffen Queinnec, Helmut Ekkerlein, et al. "Clinical Performance and Safety of 108 SpineJack Implantations: 1-Year Results of a Prospective Multicentre Single-Arm Registry Study." BioMed Research International 2015 (2015): 1–10. http://dx.doi.org/10.1155/2015/173872.
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This prospective, consecutive, multicentre observational registry aimed to confirm the safety and clinical performance of the SpineJack system for the treatment of vertebral compression fractures (VCF) of traumatic origin. We enrolled 103 patients (median age: 61.6 years) with 108 VCF due to trauma, or traumatic VCF with associated osteoporosis. Primary outcome was back pain intensity (VAS). Secondary outcomes were Oswestry Disability Index (ODI), EuroQol-VAS, and analgesic consumption. 48 hours after surgery, a median relative decrease in pain intensity of 81.5% was observed associated with a significant reduction in analgesic intake. Improvements in disability (91.3% decrease in ODI score) and in quality of life (increase 21.1% of EQ-VAS score) were obtained 3 months after surgery. All results were maintained at 12 months. A reduction in the kyphotic angulation was observed postoperatively (-5.4±6.3°;p<0.001), remained at 12 months (-4.4±6.0°,p=0.002). No adverse events were implant-related and none required device removal. Three patients (2.9%) experienced procedure-related complications. The overall adjacent fracture rate up to 1 year after surgery was 2.9%. The SpineJack procedure is an effective, low-risk procedure for patients with traumatic VCF allowing a fast and sustained improvement in quality of life over 1 year after surgery.
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Luo, Kefeng, Guoqiang Jiang, Jinjin Zhu, Bin Lu, Jiye Lu, Kai Zhang, Xiumei Wang, and Fu-Zhai Cui. "Poly(methyl methacrylate) bone cement composited with mineralized collagen for osteoporotic vertebral compression fractures in extremely old patients." Regenerative Biomaterials 7, no. 1 (January 16, 2020): 29–34. http://dx.doi.org/10.1093/rb/rbz045.
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Abstract To examine the clinical effects of a new bone cement composed of poly(methyl methacrylate) (PMMA) and mineralized collagen (MC) compared with pure PMMA bone cement in treating osteoporotic vertebral compression fractures (OVCFs) in patients aged over 80. In all, 32 cases using pure PMMA bone cement and 31 cases using MC-modified PMMA (MC-PMMA) bone cement for OVCFs between June 2014 and March 2016 were screened as PMMA group and MC-PMMA group, respectively, with an average age of over 80. The operation duration, intraoperative blood loss, hospital stay, oswestry disability index (ODI), visual analogue scale (VAS), anterior vertebral height (AVH), intermediate vertebral height (IVH) and posterior vertebral height (PVH) of injured vertebrae, vertebral computed tomography value, re-fracture rate of adjacent vertebrae, correction rate of spinal kyphotic angle and wedge-shaped vertebra angle and surgical complications were compared between the two groups. In the early post-operative period, the VAS, ODI, AVH and IVH in MC-PMMA group were comparable to those in the traditional PMMA group. Moreover, the MC-PMMA group showed better effects compared with the PMMA group 12 months after surgery. Thus, this new bone cement has superior clinic effects in the long term.
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Lee, Chang Kyu, Dong Ah Shin, Seong Yi, Keung Nyun Kim, Hyun Chul Shin, Do Heum Yoon, and Yoon Ha. "Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament." Journal of Neurosurgery: Spine 24, no. 1 (January 2016): 100–107. http://dx.doi.org/10.3171/2015.4.spine141004.
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OBJECT The goal of this study was to determine the relationship between cervical spine sagittal alignment and clinical outcomes after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament (OPLL). METHODS Fifty consecutive patients who underwent a cervical laminoplasty for OPLL between January 2012 and January 2013 and who were followed up for at least 1 year were analyzed in this study. Standing plain radiographs of the cervical spine, CT (midsagittal view), and MRI (T2-weighted sagittal view) were obtained (anteroposterior, lateral, flexion, and extension) pre- and postoperatively. Cervical spine alignment was assessed with the following 3 parameters: the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), and T-1 slope minus C2–7 Cobb angle. The change in cervical sagittal alignment was defined as the difference between the post- and preoperative C2–7 Cobb angles, C2–7 SVAs, and T-1 slope minus C2–7 Cobb angles. Outcome assessments (visual analog scale [VAS], Oswestry Neck Disability Index [NDI], 36-Item Short-Form Health Survey [SF-36], and Japanese Orthopaedic Association [JOA] scores) were obtained in all patients pre- and postoperatively. RESULTS The average patient age was 56.3 years (range 38–72 years). There were 34 male patients and 16 female patients. Cervical laminoplasty for OPLL helped alleviate radiculomyelopathy. Compared with the preoperative scores, improvement was seen in postoperative VAS and JOA scores. After laminoplasty, 35 patients had kyphotic changes, and 15 had lordotic changes. However, cervical sagittal alignment after laminoplasty was not significantly associated with clinical outcomes in terms of postoperative improvement of the JOA score (C2–7 Cobb angle: p = 0.633; C2–7 SVA: p = 0.817; T-1 slope minus C2–7 lordosis: p = 0.554), the SF-36 score (C2–7 Cobb angle: p = 0.554; C2–7 SVA: p = 0.793; T-1 slope minus C2–7 lordosis: p = 0.829), the VAS neck score (C2–7 Cobb angle: p = 0.263; C2–7 SVA: p = 0.716; T-1 slope minus C2–7 lordosis: p = 0.497), or the NDI score (C2–7 Cobb angle: p = 0.568; C2–7 SVA: p = 0.279; T-1 slope minus C2–7 lordosis: p = 0.966). Similarly, the change in cervical sagittal alignment was not related to the JOA (p = 0.604), SF-36 (p = 0.308), VAS neck (p = 0.832), or NDI (p = 0.608) scores. CONCLUSIONS Cervical laminoplasty for OPLL improved radiculomyelopathy. Cervical laminoplasty increased the probability of cervical kyphotic alignment. However, cervical sagittal alignment and clinical outcomes were not clearly related.
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Romero, Flávio, Rodolfo Vieira, and Bruno Ancheschi. "Open vs. Percutaneous Pedicle Screw Insertion for Thoracolumbar Traumatic A3 and A4 AO Fractures - 18-Months Follow-Up." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 36, no. 04 (October 27, 2017): 207–12. http://dx.doi.org/10.1055/s-0037-1607439.
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Purpose To compare the efficacy and safety of the percutaneous screw fixation (PSF) and the open pedicle screw fixation (OPSF) on thoracolumbar (TL) fracture. Methods Sixty-four adult patients with TL vertebral fractures who underwent open or percutaneous posterior short-segment transpedicular screw fixation between January of 2013 and September of 2015 were retrospectively reviewed. All patients underwent clinical, radiological and quality of life follow-up for at least 18 months. Results There was no significant difference in age, gender, time between injury and surgery, and preoperative percentage of anterior column height, preoperative sagittal regional Cobb angle, or kyphotic angle of fractured vertebra between these two groups (p > 0.05). There was significantly less intraoperative blood loss in the PSF (87.6 ± 24.6 mL) than in the OPSF group (271.4 ± 142.6 mL) (p < 0.05). The mean surgery time was 62 minutes (range 42–130 minutes) for open and 58 minutes (range 35 to 128 minutes) for percutaneous screw fixation. The surgery time was shorter in the PSF group, but with no statistical significance (p > 0.05). The mean Oswestry disability index (ODI) scores after 18-months were 23.12 ± 8.2 for the PSF and 24.12 ± 9.2 for the OPSF group, without any statistical significance (p > 0.05). Conclusion Both open and percutaneous screw fixations are safe and effective. The percutaneous techniques significantly reduced the intraoperative blood loss compared with the open techniques.
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Houten, John K., and Paul R. Cooper. "Laminectomy and Posterior Cervical Plating for Multilevel Cervical Spondylotic Myelopathy and Ossification of the Posterior Longitudinal Ligament: Effects on Cervical Alignment, Spinal Cord Compression, and Neurological Outcome." Neurosurgery 52, no. 5 (May 1, 2003): 1081–88. http://dx.doi.org/10.1093/neurosurgery/52.5.1081.
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Abstract OBJECTIVE Multilevel anterior decompressive procedures for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament may be associated with a high incidence of neurological morbidity, construct failure, and pseudoarthrosis. We theorized that laminectomy and stabilization of the cervical spine with lateral mass plates would obviate the disadvantages of anterior decompression, prevent the development of kyphotic deformity frequently seen after uninstrumented laminectomy, decompress the spinal cord, and produce neurological results equal or superior to those achieved by multilevel anterior procedures. METHODS We retrospectively reviewed the records of 38 patients who underwent laminectomy and lateral mass plating for cervical spondylotic myelopathy or ossification of the posterior longitudinal ligament between January 1994 and November 2001. Seventy-six percent of patients had spondylosis, 18% had ossification of the posterior longitudinal ligament, and 5% had both. Clinical presentation included upper extremity sensory complaints (89%), gait difficulty (70%), and hand use deterioration (67%). Spasticity was present in 83%, and weakness of one or more muscle groups was seen in 79%. Spinal cord signal abnormality on sagittal T2-weighted magnetic resonance imaging (MRI) was seen in 68%. Neurological evaluation was performed using a modification of the Japanese Orthopedic Association Scale for functional assessment of myelopathy, the Cooper Scale for separate evaluation of upper and lower extremity motor function, and a five-point scale for evaluation of strength in individual muscle groups. Lateral cervical spine x-rays were analyzed using a curvature index to determine maintenance of alignment. Each surgically decompressed level was graded on a four-point scale using axial MRI to assess the adequacy of decompression. Late follow-up was conducted by telephone interview. RESULTS Laminectomy was performed at a mean 4.6 levels. Follow-up was obtained at a mean of 30.2 months after the procedure. The score on the modified Japanese Orthopedic Association scale improved in 97% of patients from a mean of 12.9 preoperatively to 15.58 postoperatively (P< 0.0001). In the upper extremities, function measured by the Cooper Scale improved from 1.8 to 0.7 (P< 0.0001), and in the lower extremities, function improved from 1.0 to 0.4 (P< 0.0002). There was a statistically significant improvement in strength in the triceps (P< 0.0001), iliopsoas (P< 0.0002), and hand intrinsic muscles (P< 0.0001). X-rays obtained at a mean of 5.9 months after surgery revealed no change in spinal alignment as measured by the curvature index. There was a decrease in the mean preoperative compression grade from 2.46 preoperatively to 0.16 postoperatively (P< 0.0001). There was no correlation between neurological outcome and the presence of spinal cord signal change on T2-weighted MRI scans, patient age, duration of symptoms, or preoperative medical comorbidity. CONCLUSION Multilevel laminectomy and instrumentation with lateral mass plates is associated with minimal morbidity, provides excellent decompression of the spinal cord (as visualized on MRI), produces immediate stability of the cervical spine, prevents kyphotic deformity, and precludes further development of spondylosis at fused levels. Neurological outcome is equal or superior to multilevel anterior procedures and prevents spinal deformity associated with laminoplasty or noninstrumented laminectomy.
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Jo, Dae-Jean, Yong-Sang Kim, Sung-Min Kim, Ki-Tack Kim, and Eun-Min Seo. "Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis." Journal of Neurosurgery: Spine 23, no. 4 (October 2015): 510–17. http://dx.doi.org/10.3171/2015.1.spine131011.
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OBJECT Most thoracolumbar fractures have a good healing outcome with adequate treatment. However, posttraumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment, osteoporosis, or osteonecrosis of the vertebral body. There are several surgical options to correct posttraumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of success. The aim of this study was to assess the use of a modified closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated using this technique. METHODS Thirteen consecutive patients with symptomatic posttraumatic thoracolumbar kyphosis were treated using a modified closing wedge osteotomy. The mean patient age was 62 years. The kyphosis apex ranged from T-10 to L-2. The sagittal alignment, kyphotic angle, neurological function, visual analog scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. RESULTS The mean preoperative regional angle was 27. 4°, and the mean correction angle was 29. 6°. Sagittal alignment improved with a mean correction rate of 58. 3%. The mean surgical time was 275 minutes, and the mean intraoperative blood loss was 1585 ml. The intraoperative complications included 2 dural tears, 1 nerve root injury, and 1 superficial wound infection. The mean visual analog scale score for back pain improved from 6. 6 to 2, and the Oswestry Disability Index score decreased from 55. 4 to 22. 6 at the last follow-up. All patients achieved bony anterior fusion based on the presence of trabecular bone bridging at the osteotomy site. CONCLUTIONS The modified posterior closing wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and fewer complications. It is an alternative method for treating patients with posttraumatic thoracolumbar kyphosis.
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Rajoli, Sreekanth Reddy, Rishi Mugesh Kanna, Siddharth N. Aiyer, Ajoy Prasad Shetty, and Shanmuganathan Rajasekaran. "Circumferential Fusion through All-Posterior Approach in Andersson Lesion." Asian Spine Journal 11, no. 3 (June 30, 2017): 444–53. http://dx.doi.org/10.4184/asj.2017.11.3.444.
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<sec><title>Study Design</title><p>Retrospective case series.</p></sec><sec><title>Purpose</title><p>To assess safety and efficacy of single stage, posterior stabilisation and anterior cage reconstruction through the transforaminal or lateral extra-cavitary route for Andersson lesions.</p></sec><sec><title>Overview of Literature</title><p>Pseudoarthrosis in ankylosing spondylitis (Andersson lesion, AL) can cause progressive kyphosis and neurological deficit. Management involves early recognition and surgical stabilisation in patients with instability. However, the need and safety of anterior reconstruction of the vertebral body defect remains unclear.</p></sec><sec><title>Methods</title><p>Twenty consecutive patients with AL whom presented with instability back pain and or neurological deficit were managed by single stage posterior approach with long segment pedicle screw fixation and anterior vertebral reconstruction. Radiological evaluation included- the regional kyphotic angle, measurement of anterior defect in computed tomography (CT) scan and the spinal cord status in magnetic resonance imaging. Radiological outcomes were assessed for fusion and kyphosis correction. Functional outcomes were assessed with visual analogue scale (VAS), ankylosing spondylitis quality of life (ASQoL) and Oswestry disability index (ODI).</p></sec><sec><title>Results</title><p>The mean age of the patients was 50.1 years (male, 18; female, 2). The levels affected include thoracolumbar (n=12), lower thoracic (n=5) and lumbar (n=3) regions. The mean level of fixation was 6.2±2.4 vertebrae. The mean anterior column defect was 1.6±0.6 cm. The mean surgical duration, blood loss and hospital stay were 112 minutes, 452 mL and 6.2 days, respectively. The mean followup was 2.1 years. At final follow up, VAS for back pain improved from 8.2 to 2.4 while ODI improved from 62.7 to 18.5 (<italic>p</italic> <0.05) and ASQoL improved from 14.3±2.08 to 7.90±1.48 (<italic>p</italic> <0.05). All patients had achieved radiological union at a mean 7.2±4.6 months. The mean regional kyphotic angle was 27° preoperatively, 16.7° postoperatively and 18.1° at the final follow-up.</p></sec><sec><title>Conclusions</title><p>Posterior stabilisation and anterior reconstruction with cage through an all-posterior approach is safe and can achieve good results in Andersson lesions.</p></sec>
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Ahsan, Md Kamrul, Om Prakash Pandit, and Md Shahidul Islam Khan. "Percutaneous vertebroplasty for symptomatic osteoporotic compression fractures: A single–center prospective study." Surgical Neurology International 12 (April 19, 2021): 176. http://dx.doi.org/10.25259/sni_212_2021.
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Background: Osteoporotic vertebral compression fractures (OVCFs) increasingly occur with advancing age, and are associated with significant morbidity, mortality, and cost. We assessed the clinical efficacy, radiological, and functional outcomes for patients undergoing percutaneous vertebroplasty (PVP) due to OVCFs, with a special focus on the frequency of new vertebral compression fractures (VCFs). Methods: This study, carried from 2018 to 2020, included 22 females and 4 males. They averaged 60.15 years of age (range, 50–70) were followed an average of 14.5 months (range 12–36 months), and had 30 VCFs between the T7–L2 levels. Multiple variables were studied, including; anterior vertebral height (AVH) and kyphotic angle (KA), new VCFs, and functional outcomes. Results: The postoperative Visual Analog Scale and Oswestry Disability Index were significantly reduced at 12 months after PVP. Improvements for AVH and KA were also statistically significant; 23 patients (88.46%) had a dramatic decrease in pain on post-operative day 1, while 3 patients (11.53%) had no decrease in pain after PVP on post-operative day 1–1 postoperative month. No major complications were observed except high incidence of cement leakage at 8 levels (26.67%) in 6 patients. Additionally, new VCFs occurred in 10 vertebrae in 8 patients (30.76%), involving 6 adjacent (60%), and 4 nonadjacent vertebrae (40%). Conclusion: PVP is an effective procedure in the management of painful OVCFs refractory to medical treatment. These PVP procedures yield immediate vertebral stabilization, relieve pain, and restore function with minimal associated morbidity.
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P. Oprel, Pim, Wim E. Tuinebreijer, Peter Patka, and Dennis den Hartog. "Combined Anterior-Posterior Surgery Versus Posterior Surgery for Thoracolumbar Burst Fractures: A Systematic Review of the Literature." Open Orthopaedics Journal 4, no. 1 (February 17, 2010): 93–100. http://dx.doi.org/10.2174/1874325001004010093.
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Study Design: A systematic quantitative review of the literature. Objective: To compare combined anterior-posterior surgery versus posterior surgery for thoracolumbar fractures in order to identify better treatments. Summary of Background Data: Axial load of the anterior and middle column of the spine can lead to a burst fracture in the vertebral body. The management of thoracolumbar burst fractures remains controversial. The goals of operative treatment are fracture reduction, fixation and decompressing the neural canal. For this, different operative methods are developed, for instance, the posterior and the combined anterior-posterior approach. Recent systematic qualitative reviews comparing these methods are lacking. Methods: We conducted an electronic search of MEDLINE, EMBASE, LILACS and the Cochrane Central Register for Controlled Trials. Results: Five observational comparative studies and no randomized clinical trials comparing the combined anteriorposterior approach with the posterior approach were retrieved. The total enrollment of patients in these studies was 755 patients. The results were expressed as relative risk (RR) for dichotomous outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI). Conclusions: A small significantly higher kyphotic correction and improvement of vertebral height (sagittal index) observed for the combined anterior-posterior group is cancelled out by more blood loss, longer operation time, longer hospital stay, higher costs and a possible higher intra- and postoperative complication rate requiring re-operation and the possibility of a worsened Hannover spine score. The surgeons’ choices regarding the operative approach are biased: worse cases tended to undergo the combined anterior-posterior approach.
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Ohlendorf, Daniela, Vanessa Fisch, Charlotte Doerry, Sebastian Schamberger, Gerhard Oremek, Hanns Ackermann, and Johannes Schulze. "Standard reference values of the upper body posture in healthy young female adults in Germany: an observational study." BMJ Open 8, no. 8 (August 2018): e022236. http://dx.doi.org/10.1136/bmjopen-2018-022236.
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ObjectiveClassifications of posture deviations are only possible compared with standard values. However, standard values have been published for healthy male adults but not for female adults.DesignObservational study.SettingInstitute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main.Participants106healthy female volunteers (21–30 years old; 25.1±2.7 years) were included. Their body weight ranged from 46 to 106 kg (60.3±7.9 kg), the heights from 1.53 to 1.82 m (1.69±0.06 m) and the body mass index from 16.9 kg/m² to 37.6 kg/m² (21.1±2.6 kg/m²).Outcome measuresA three-dimensional back scan was performed to measure the upper back posture in habitual standing. The tolerance ranges and CI were calculated. Group differences were tested by the Wilcoxon Mann-Whitney U test.ResultsIn normal posture, the spinal column was marginally twisted to the left, and the vertebrae were marginally rotated to the right. The kyphosis angle is larger than the lumbar angle. Consequently, a more kyphotic posture is observed in the sagittal plane. The habitual posture is slightly scoliotic with a rotational component (scapular depression right, right scapula marginally more dorsally, high state of pelvic right, iliac right further rotated anteriorly).ConclusionsHealthy young women have an almost ideally balanced posture with minimal ventral body inclination and a marginal scoliotic deviation. Compared with young males, women show only marginal differences in the upper body posture. These values allow a comparison to other studies, both for control and patient data, and may serve as guideline in both clinical practice and scientific studies.
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Zhong, Junlong, Zhimin Pan, Yiwei Chen, Haoqun Yao, Zujue Cheng, Quanfei Liu, Zhaoxun Zeng, et al. "Postoperative Cervical Sagittal Realignment Improves Patient-Reported Outcomes in Chronic Atlantoaxial Anterior Dislocation." Operative Neurosurgery 15, no. 6 (March 20, 2018): 643–50. http://dx.doi.org/10.1093/ons/opy035.
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Abstract BACKGROUND Chronic atlantoaxial anterior dislocation (AAD) not only results in myelopathy, but dislocation-related kyphosis also results in cervical malalignment, which permanently affects neck function and patient-reported outcomes (PROs). OBJECTIVE To investigate the effect of kyphotic correction on realigning cervical spine and independent cervical alignment parameters, which may be correlated with an improvement of PROs. METHODS The study included 21 patients with chronic AAD-related kyphosis who underwent C1-2 reduction and correction surgery. Radiographic parameters were measured to assess cervical realignment preoperatively and postoperatively. Neck disability index (NDI), short form 12 physical component summary (SF-12 PCS), and Japanese Orthopaedic Association (JOA) scores were recorded to reveal changes in PROs. The independent parameters correlated with the improvements of PROs were analyzed. RESULTS Of the radiographic parameters, the C1-2 Cobb angle, the C2-7 Cobb angle, thoracic inlet angle, cervical tilt, and T1 slope were significantly changed from −4.0° ± 16.2°, −29.2° ± 11.2°, 73.1° ± 13.3°, 30.4° ± 8.5°, and 29.1° ± 8.8° preoperatively to −13.5° ± 8.1° (P = .005), −18.0° ± 12.0° (P < .001), 67.1° ± 11.6° (P = .042), 23.1° ± 10.3° (P = .007), and 24.0° ± 7.0° (P = .011) at last follow-up, respectively. NDI, JOA, and SF-12 PCS scores were significantly improved postoperatively. The C1-2 Cobb angle was an independent parameter correlated with the improvements in SF-12 PCS, NDI, and JOA scores. CONCLUSION Correction and reduction surgery can realign cervical spine in chronic AAD patients. The C1-2 Cobb angle was an independent parameter correlated with the improvements of PROs.
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Park, Hyung-Youl, Ki-Won Kim, Ji-Hyun Ryu, S. Tim Yoon, In-Hwa Baek, Tae-Yang Jang, and Jun-Seok Lee. "Long-Segmental Posterior Fusion Combined With Vertebroplasty and Wiring: Alternative Surgical Technique for Kummell’s Disease With Neurologic Deficits – A Retrospective Case Series." Geriatric Orthopaedic Surgery & Rehabilitation 12 (January 1, 2021): 215145932110270. http://dx.doi.org/10.1177/21514593211027055.
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Purpose: Various surgical methods have been reported for Kummell’s disease with neurologic deficits. The aim of this study was to introduce long-segmental posterior fusion (LPF) combined with vertebroplasty (VP) and wiring as an alternative surgical technique. Material and Methods: We retrospectively analyzed 10 patients undergoing posterior decompression and LPF combined with VP and wiring for Kummell’s disease with neurologic deficits from January 2011 to December 2014. The radiologic outcomes included the local kyphotic angle (LKA) and vertebral wedge angle (VWA). Clinical outcomes, including the visual analog scale (VAS), the Oswestry Disability Index (ODI) and the Frankel grade were assessed. Surgery-related complications were also evaluated. Results: The mean age of the included patients was 77 ± 8 years with a mean follow-up period of 31.4 ± 4.9 months and a mean bone mineral density of −3.5 ± 0.7 (T-score). The mean operation time was 220 ± 32.3 minutes with a mean blood loss of 555 ± 125.7 mL. The preoperative LKA and VWA were significantly corrected postoperatively (37.9 ± 8.7° vs. 15.3 ± 5.3°, p = 0.005 for LKA; 21.3 ± 5.1° vs. 7.6 ± 2.8°, p = 0.005 for VWA) without a loss of correction at the last follow-up. The VAS and ODI were also significantly improved (7.7 ± 1.1 vs. 3.0 ± 1.6, p = 0.007 for VAS; 90.3 ± 8.9 vs. 49.6 ± 22.7, p = 0.007 for ODI). The Frankel grade of all patients was improved by at least 1 or 2 grades at the last follow-up. Surgery-related complications such as intraoperative cement leakage and implant loosening during the follow-up were not observed. Conclusions: LPF combined with VP and wiring might be an effective surgical option for Kummell’s disease with neurologic deficits, especially for the elderly patients with morbidities. Level of Evidence: level IV.
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Yang, Yan. "Percutaneous Kyphoplasty for Kummell Disease with Severe Spinal Canal Stenosis." Pain Physician 6;18, no. 6;11 (November 14, 2015): E1021—E1028. http://dx.doi.org/10.36076/ppj.2015/18/e1021.
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Background: Percutaneous kyphoplasty (PKP) has been proven as an effective, minimally invasive procedure for the treatment of Kummell’s disease in the early stages. However, a risk of cement leakage and further neurological damage remains during and after PKP, especially in chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Objective: To evaluate the feasibility and efficacy of PKP for the treatment of chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Study Design: A retrospective evaluation of postoperative radiographs. Setting: Pain management clinic. Methods: A retrospective study was performed on 9 patients with 11 levels managed with PKP for chronic osteoporotic stage III Kummell’s disease with severe spinal canal stenosis. Clinical and radiological outcomes were assessed. Results: Substantial pain relief was attained in all the patients. Both visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores improved significantly from pre- to post-operation (P < 0.05), and remained unchanged at every follow-up. No neurological deterioration was found. Postoperatively, the anterior and midline vertebral body heights were significantly corrected (P < 0.05), and were sustained at the final follow-up. Similar results were seen in the correction of kyphotic angle. Neither cement leakage into the spinal canal nor further dislodging of the posterior vertebral fragments occurred. Two cases experienced subsequent fractures with one having a second PKP and the other being treated conservatively. Limitations: Retrospective study of 9 cases with 11 levels due partly to the rarity of the disorder. Conclusions: PKP is an effective, minimally invasive procedure for the treatment of chronic osteoporotic stage III Kummell’s disease with severe spinal stenosis, leading to a significant relief of symptoms and improvement of functional status. Institutional Review: This study was approved by the Institutional Review Board. Key words: Kummell’s disease, kyphoplasty, spine, osteoporosis, cement leakage, polymethylmethacrylate, neurological deficits, burst fractures
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Deviren, Vedat, Justin K. Scheer, and Christopher P. Ames. "Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases." Journal of Neurosurgery: Spine 15, no. 2 (August 2011): 174–81. http://dx.doi.org/10.3171/2011.3.spine10536.
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Object Sagittal imbalance of the cervicothoracic spine often causes severe pain and loss of horizontal gaze. Historically, the Smith-Peterson osteotomy has been used to restore sagittal balance. Cervicothoracic junction pedicle subtraction osteotomy (PSO) offers more controlled closure and greater biomechanical stability but has been infrequently reported in the literature. This study details the cervicothoracic PSO technique in 11 cases and correlates clinical kyphosis (chin-brow to vertical angle [CBVA]) with radiographic measurements. Methods Between February 2008 and September 2010, 11 patients (mean age 70 years) underwent a modified PSO (10 at C-7, 1 at T-1) for treatment of sagittal imbalance. Preoperative and postoperative sagittal plane radiographic measurements were made. The CBVA was measured on clinical photographs. Operative technique and perioperative correction were reported for all 11 patients and long-term follow-up data was reported for 9 patients, in whom the mean duration of follow-up was 23 months. Outcome measures used for these 9 patients were the Neck Disability Index, the 36-Item Short Form Health Survey (SF-36), and a visual analog scale for neck pain. Results The mean values for estimated blood loss, surgical time, and hospital stay in the 11 patients were 1100 ml, 4.3 hours, and 9.9 days, respectively. The mean preoperative and immediate postoperative values (± SD) for cervical sagittal imbalance were 7.9 ± 1.4 cm and 3.4 ± 1.7 cm. The mean overall correction was 4.5 ± 1.5 cm (42.8%), the mean PSO correction 19.0°, and the mean CBVA correction 36.7°. There was essentially no correlation between preoperative C2–T1 radiographic kyphosis and preoperative CBVA (R2 = 0.0165). There was a moderate correlation with PSO correction angle and postoperative CBVA (R2 = 0.38). There was a significant decrease in both the Neck Disability Index (51.1 to 38.6, p = 0.03) and visual analog scale scores for neck pain (8.1 to 3.9, p = 0.0021). The SF-36 physical component summary scores increased by 18.4% (30.2 to 35.8) with no neurological complications. Conclusions The cervicothoracic junction PSO is a safe and effective procedure for the management of cervicothoracic kyphotic deformity. It results in excellent correction of cervical kyphosis and CBVA with a controlled closure and improvement in health-related quality-of-life measures even at early time points.
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Zheng, Zhaomin. "Comparison of Percutaneous Vertebroplasty and Balloon Kyphoplasty for the Treatment of Single Level Vertebral Compression Fractures: A Meta-analysis of the Literature." May 2015 3;18, no. 3;5 (May 14, 2015): 209–21. http://dx.doi.org/10.36076/ppj/2015.18.209.
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Background: Percutaneous vertebroplasty (PVP) and percutaneous balloon kyphoplasty (PKP) can increase bone strength as well as alleviate the pain caused by vertebral compression fractures (VCFs), and both procedures rely on polymethyl methacrylate (PMMA) cement injected into the fractured vertebra for mechanical stabilization of the VCFs. However, there is debate over which of these 2 surgical procedures can give better short-term and long-term outcomes. A lot of studies and meta-analysis were designed to assess the advantages and drawbacks of PKP and PVP in the treatment of VCFs, but most of them didn’t consider the effect of VCF levels on the treatment outcome, which can influence the results. Objective: To assess the safety and efficacy of PKP compared to PVP in the treatment of single level osteoporotic vertebral compression fractures (OVCF). Study Design: Studies with the following criteria were included: patients with VCFs due to osteoporosis; PKP comparing PVP; study design, RCT or prospective or retrospective comparative studies. Furthermore, the studies which reported at least one of the following outcomes: subjective pain perception, quality of life evaluation, incidence of new adjacent vertebral fracture, bone cement leakage, and post-operative kyphotic angle. Articles were excluded in our meta-analysis if they had a neoplastic etiology (i.e., metastasis or myeloma), infection, neural compression, traumatic fracture, neurological deficit, spinal stenosis, severe degenerative diseases of the spine, previous surgery at the involved vertebral body, and PKP or PVP with other invasive or semi-invasive intervention treatment. Setting: University hospital. Methods: A systematic search of all articles published through May 2014 was performed by Medline, EMASE, OVID, and other databases. All the articles that compared PKP with PVP on single level OVCF were identified. The evidence quality levels of the selected articles were evaluated by Grade system. Data about the clinical outcomes and complications were extracted and analyzed. Results: Eight studies, encompassing 845 patients, met the inclusion criteria. Overall, the results indicated that there were significant differences between the 2 groups in the short-term visual analog scale (VAS) scores, the long-term Oswestry Disability Index (ODI), short- and long-term kyphosis angle, the kyphosis angle improvement, the injected cement, and the cement leakage rates. However, there were no significant differences in the long-term VAS scores, the short-term ODI scores, the short- and long-term SF-36 scores, or the adjacent-level fracture rates. Limitations: Statistical efficacy can be improved by more studies, low evidence based non-RCT articles are likely to induce various types of bias, no accurate definition of short-term and long-term outcome time points. Conclusion: PKP and PVP are both safe and effective surgical procedures in treating OVCF. PKP has a similar long-term pain relief, function outcome (short-term ODI scores, short-and long-term SF-36 scores), and new adjacent VCFs in comparison to PVP. PKP is superior to PVP for the injected cement volume, the short-term pain relief, the improvement of short- and long-term kyphotic angle, and lower cement leakage rate. However, PKP has a longer operation time and higher material cost than PVP. To confirm this evaluation, a large multi-center randomized controlled trial (RCT) should be conducted. Key words: Percutaneous, kyphoplasty, vertebroplasty, osteoporosis vertebral compression fracture, pain, meta-analysis Pain Physician 201
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Ke, Chen Rong. "The Role of Unilateral Balloon Kyphoplasty for the Treatment of Patients with OVCFS: A Systematic Review and Meta-Analysis." January 2018 1, no. 21;1 (May 15, 2018): 209–18. http://dx.doi.org/10.36076/ppj.2018.3.209.
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Background: An increasing number of studies have been conducted to apply unilateral balloon kyphoplasty in the treatment of ostroporotic vertebral compression fractures (OVCFs). However, the efficacy and safety of unilateral kyphoplasty and whether a unilateral or a bilateral approach is superior is controversial. Objectives: The purpose of this study was to evaluate the role of unilateral balloon kyphoplasty and use meta-analysis to compare the efficacy and safety of unilateral and bilateral kyphoplasty in patients with OVCFs. Study Design: A systematic literature search was conducted from 1970 to April 2017 using Medline database and the Cochrane Central Register of Controlled Trials. Articles were limited to those published in English. Randomized controlled trials and nonrandomized comparative studies were also included. Setting: The following search terms were used: “osteoporotic vertebral compression fractures,” or “OVCF,” and “unilateral kyphoplasty,” or “unipedicular approach,” or “single balloon kyphoplasty,” or “one balloon kyphoplasty.” A comprehensive search of reference lists of retrieved articles and previous published reviews was also performed to ensure inclusion of all possible studies. Methods: All potential articles were independently reviewed by 2 investigators for inclusion into the final analysis. MINORS score was used for nonrandomized studies, and Detsky quality index was applied for prospective randomized controlled trials. Systematic review and meta-analysis was performed for the included studies. Results: After unilateral balloon kyphoplasty the mean postoperative visual analog score (VAS) was from 1.74 to 4.77, mean postoperative kyphotic angle was from 5.9º to 11.22º, and complications involving cement leaks was from 6.8 to 21.9% or adjacent level fractures was from 0 to 5.6%). Unilateral kyphoplasty had significantly lower operative time, and less bone cement volume; however, the postoperative VAS, Oswestry Disability Index (ODI), vertebral height restoration rate, and cement leakage and adjacent vertebral fracture rate, were similar to bilateral kyphoplasty. Limitations: Only 6 randomized controlled trials and 3 retrospective comparative studies were selected for analysis. Heterogeneity was detected among the studies when we pooled the outcomes. Conclusions: Based on the available evidence, the clinical and radiological results of unilateral balloon kyphoplasty were as good as those of bilateral balloon kyphoplasty for the treatment of OVCFs. And unilateral kyphoplasty had advantages in terms of operation time, radiation exposure, and cost. Key words: Unilateral balloon kyphoplasty, bilateral balloon kyphoplasty, osteoporotic vertebral compression fractures, complications of balloon kyphoplasty, meta-analysis
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Stoffel, Michael, Iris Wolf, Florian Ringel, Carsten Stüer, Horst Urbach, and Bernhard Meyer. "Treatment of painful osteoporotic compression and burst fractures using kyphoplasty: a prospective observational design." Journal of Neurosurgery: Spine 6, no. 4 (April 2007): 313–19. http://dx.doi.org/10.3171/spi.2007.6.4.5.
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Object The aim of this study was to test the hypothesis that kyphoplasty is an effective treatment in painful osteoporotic vertebral fractures, even with involvement of the posterior cortical wall. Methods Between December 2001 and May 2004, 74 consecutive patients were treated with kyphoplasty for 118 painful osteoporotic compression (38%) or burst (62%) fractures. Additional decompression of the spinal canal was performed in six patients, internal fixation in three. Data were collected in a prospective observational design until May 2005. The preoperative workup included neuroimaging (plain x-ray films, densitometry, short tau inversion recovery magnetic resonance imaging, and computed tomography scanning) and clinical parameters (general and neurological examinations, visual analog scale [VAS], Karnofsky Performance Scale [KPS], and 36-Item Short Form Health Survey [SF]–36). At predefined time intervals (at discharge and 6 weeks and 3, 6, 12, and 24 months post-therapy) the patients were evaluated (x-ray films, neurological status, VAS, KPS, and SF-36). Kyphoplasty led to a significant reduction in kyphotic deformity (mean ± standard error of the mean, sagittal index: preoperative 10 ± 1°, postoperative 5 ± 1°), and an improvement in pain (VAS: preoperative 70 ± 3, postoperative 23 ± 2), activity (KPS score: preoperative 51 ± 3, postoperative 71 ± 2), and mental and physical health (SF-36, mental status: preoperative 43, postoperative 58; SF-36, physical status: preoperative 24, postoperative 35). No secondary narrowing of the spinal canal by the retropulsed posterior wall was observed after the procedure. Clinical improvement was durable (mean follow up 15 ± 1.1 months), although the VAS score secondarily increased slightly. All patients, who suffered from a compression-induced motor deficit, recovered completely during the follow-up interval. The main procedural complications consisted of one symptomatic extravertebral cement leakage (permanent monoparesis) requiring open revision, two nerve root contusions (transient radiculopathy), and one wound infection. Conclusions Kyphoplasty is effective in the treatment of painful osteoporotic vertebral compression and burst fractures, at least under medium-term conditions. The potential complication of procedure-related secondary narrowing of the spinal canal by the retropulsed posterior wall in burst fractures appears to be more of a theoretical than an actual risk.
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Zou, Tianming. "Clinical Efficacy of Different Bone Cement Distribution Patterns in Percutaneous Kyphoplasty: A Retrospective Study." Pain Physician 4;23, no. 7;4 (July 14, 2020): E409—E416. http://dx.doi.org/10.36076/ppj.2020/23/e409.
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Background: Bone cement distribution patterns in percutaneous kyphoplasty (PKP) is the key factor in keeping the vertebral stabilization and curative effect. However, the same cement volume can result in different bone cement distribution patterns and can thereby lead to different clinical outcomes. Therefore we investigated associations between cement distribution patterns and the occurrence rates of recompression in cemented vertebrae after PKP for patients with osteoporotic vertebral compression fractures (OVCFs). Objectives: The study focuses attention on the influence of compact and dispersive cement distribution patterns in PKP for patients with OVCFs. Study Design: A retrospective cohort study. Setting: An affiliated people’s hospital of a university. Methods: According to different cement distribution patterns, patients were assigned to 4 groups. The demographic data, radiographic data, and clinical outcomes were compared between the 4 groups. The Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were evaluated before and 2 days after PKP. Moreover, the relationships between bone cement and clinical outcomes were analyzed. The epidemiologic data, clinical outcomes, and complications of the 4 groups were assessed. Comparisons of the radiologic and clinical results of the 4 groups were made pre- and postoperatively. Anterior height of fractured vertebrae (AH), the kyphotic Cobb angle, and the volumetric cubage index of the fractured vertebrae were measured. Results: A total of 104 subjects were retrospectively analyzed and followed up (median age, 75.01 ± 8.42 years; age range, 56–94 years). The mean procedure duration was 61.26 ± 23.05 minutes (range, 30–140 minutes). The mean follow-up was 12.1 ± 2.2 months (range, 2–15 months). Statistically, there was no significant difference in terms of gender, age, body mass index, and bone mineral density (P > 0.05). The incidence of cement leakage was significantly lower in group A than those in the other groups. The total amount of bone cement injected into 104 cases (104 vertebral bodies in total) was 848.5 mL, and the amount of bone cement injected into a single vertebral body was 7.94 ± 1.38 mL. The amount of bone cement injection in each group was the lowest (6.80 ± 1.66 mL) in group D, followed by (7.94 ± 1.38 mL) group B, and the highest (8.96 ± 1.68 mL) in group A, with a statistically significant difference between the 4 groups (P < 0.05). No serious complications were observed during the follow-up periods. The AH and Cobb angle improved significantly for the 4 groups (P < 0.05). The VAS score decreased from 3.55 ± 0.54, 3.53 ± 0.65, 3.40 ± 0.58, and 3.40 ± 0.66 preoperatively to 0.18 ± 0.39, 0.23 ± 0.41, 0.20 ± 0.40, and 0.15 ± 0.36 at 48 hours postoperatively. The ODI score dropped from 35.65 ± 4.54, 36.45 ± 4.72, 34.12 ± 4.86, and 35.65 ± 4.34 preoperatively to 15.47 ± 1.32, 15.32 ± 1.34, 15.23 ± 1.26, and 15.73 ± 1.17 at 48 hours postoperatively. Limitations: Our estimation of the vertebral body volume is imprecise. In addition, the number of subjects with OVCFs was small in this retrospective study. The volume of the fractured vertebra was not calculated accurately. Conclusions: Significant associations between cement distribution patterns and bone cement leakage affected the clinical outcome in patients after PKP. A higher incidence of bone cement leakage was observed in patients with treated vertebrae exhibiting a single-dispersive or single-compact pattern. Key words: Percutaneous kyphoplasty, osteoporotic vertebral compression fracture, bone cement distribution patterns