PEDICLE SUBTRACTION OSTEOTOMY ASSISTED WITH ANTERIOR COLUMN RECONSTRUCTION FOR TREATMENT OF CHRONIC OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 ZHOUJianwei , MAYuquan , WANGFei , XUEZhixing , ZHANGJianzhong

Spine Division, Orthopedic Department, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, P. R. China;

Corresponding author：

ZHOUJianwei, Email: zjw7574@sina.com

Keywords：

Osteoporosis vertebral compression fracture; Pedicle subtraction osteotomy; Anterior column reconstruction

DOI：

10.7507/1002-1892.20160116

Video：

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Objective To evaluate the effectiveness of pedicle subtraction osteotomy (PSO) assisted with anterior column reconstruction in the treatment of chronic osteoporotic vertebral compression fracture (OVCF). Methods Between January 2008 and October 2014, 11 cases of chronic OVCF were treated. There were 2 males and 9 females, aged 65-76 years (mean, 72.3 years). The vertebral compression fracture segment involved T₁₁ in 2 cases, T₁₂ in 2 cases, L₁ in 4 cases, L₂ in 2 cases, and L₃ in 1 case. At preoperation, the Oswestry disability index (ODI) score was 31.1±10.2; kyphosis Cobb angle of fractured vertebrae was (36.5±10.2)° on the lateral X-ray films of the spine; and distance between C₇ plumb vertical line (C₇ PL) and sagittal vertical axis (SVA) of the S₁ superior border was (5.2±2.5) cm. Six cases had spinal cord injury (SCI), including 4 cases of Frankel grade C and 2 cases of grade D. At last follow-up, ODI score, kyphosis Cobb angle of fractured vertebrae, and distance between C₇ PL and SVA were recorded and compared with preoperative values. Postoperative Frankle scores were recorded in SCI cases. X-ray film and CT scan were taken to evaluate bone fusion at 12 months after operation. Results The operation was completed successfully without serious complications. Nerve root radiation symptoms occurred in 2 cases undergoing lumbar PSO, which was relieved after conservative treatment. Cerebrospinal fluid leakage occurred in 1 case and was cured after 2 weeks. All cases were followed up 12-24 months (mean, 15.6 months). No internal fixation failure or pseudarthrosis was found postoperatively.Screw loosening was found in 1 case (2 screws of the upper level) and titanium Cage cutting vertebral body was found in 1 case. Bone fusion was obtained in all cases at 12 months after operation. At last follow-up, ODI score was significantly improved to 13.7±5.7(t=4.417, P=0.018), kyphosis Cobb angle of fractured vertebrae to (7.0±15.2)° (t=5.113, P=0.009), and the distance between C₇ PL and SVA to (2.8±2.2) cm (t=3.285, P=0.032). In 6 SCI cases, Frankle grade was recovered to E (1 case), to D (1 case), and no improvement (2 cases) from C, and to E from D (2 cases). Conclusion PSO assisted anterior column reconstruction was an effective method in treatment of chronic OVCF.

Citation： ZHOUJianwei, MAYuquan, WANGFei, XUEZhixing, ZHANGJianzhong. PEDICLE SUBTRACTION OSTEOTOMY ASSISTED WITH ANTERIOR COLUMN RECONSTRUCTION FOR TREATMENT OF CHRONIC OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(5): 575-579. doi: 10.7507/1002-1892.20160116 Copy

1.	Wong CC, McGirt MJ. Vertebral compression fractures:a review of current management and multimodal therapy. J Multidiscip Healthc, 2013, 6:205-214.
2.	Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie, 1987, 33(2):166-168.
3.	邹德威, 马华松, 邵水霖, 等. 球囊扩张椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折. 中华骨科杂志, 2003, 23(5):257-261.
4.	Suk SI, Kim JH, Lee SM, et al. Anteriorposterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine (Phila Pa 1976), 2003, 28(18):2170-2175.
5.	Sasani M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine (Phila Pa 1976), 2009, 34(1):E33-40.
6.	Rzewuska M, Ferreira M, McLachlan AJ, et al. The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief:a systematic review with meta-analysis. Eur Spine J, 2015, 24(4):702-714.
7.	Bouza C, López-Cuadrado T, Almendro N, et al. Safety of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures in Europe:a meta-analysis of randomized controlled trials. Eur Spine J, 2015, 24(4):715-723.
8.	Ensrud KE, Schousboe JT. Clinical practice. Vertebral fractures. N Engl J Med, 2011, 364(17):1634-1642.
9.	Kempisky WH, Morgan PP, Boniface WR. Osteoporosis kyphosis with paraplegia. Neurology, 1958, 8(3):181-186.
10.	Lee YL, Yip KM. The osteoporosis spine. Clin Orthop Relat Res, 1996, (323):91-97.
11.	Shikata J, Yamamuro T, Iida H, et al. Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis. Spine (Phila Pa 1976), 1990, 15(6):485-489.
12.	Kaneda K, Asano S, Hashimoto T, et al. The treatment of osteoporotic posttraumatic vertebral collapse using the Kaneda device and bioactive ceramic vertebral prosthesis. Spine (Phila Pa 1976), 1992, 17(8 Suppl):S295-303.
13.	Suk SI, Kim JH, Lee SM, et al. Anteriorposterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine (Phila Pa 1976), 2003, 28(18):2170-2175.
14.	Metcalfe S, Gbejuade H, Patel NR. The posterior transpedicular approach for circumferential decompression and instrumented stabilization with titanium cage vertebrectomy reconstruction for spinal tumors. Spine (Phila Pa 1976), 2012, 37(16):1375-1383.
15.	Burval DJ, McLain RF, Milks R, et al. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae:biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976), 2007, 32(10):1077-1083.
16.	薛海滨, 马远征, 王亮, 等. 骨水泥加强椎弓根螺钉内固定治疗伴骨质疏松症的腰椎退行性病变. 中国骨质疏松杂志, 2011, 17(1):24-27, 34.
17.	赵洪普, 徐秋玉, 吕玉明, 等. 膨胀式椎弓根钉系统治疗椎体骨质疏松性骨折. 中国矫形外科杂志, 2012, 20(14):1265-1267.
18.	Cho W, Cho SK, Wu C. The biomechanics of pedicle screw-based instrumentation. J Bone Joint Surg (Br), 2010, 92(8):1061-1065.
19.	Patil S, Rawall S, Singh D, et al. Surgical patterns in osteoporotic vertebral compression fractures. Eur Spine J, 2013, 22(4):883-891.
20.	Uchida K, Kobayashi S, Matsuzaki M, et al. Anterior versus posterior surgery for osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine. Eur Spine J, 2006, 15(12):1759-1767.
21.	Okuda S, Oda T, Yamasaki R, et al. Surgical outcomes of osteoporotic vertebral collapse:a retrospective study of anterior spinal fusion and pedicle substraction osteotomy. Global Spine J, 2012, 2(4):221-226.
22.	Rawall S, Singh D, Mohan K, et al. Surgical patterns in osteoporotic vertebral compression fractures. Eur Spine J, 2013, 22(4):883-891.
23.	Takenaka S, Mukai Y, Hosono N, et al. Major surgical treatment of osteoporotic vertebral fractures in the elderly:a comparison of anterior spinal fusion, anterior-posterior combined surgery and posterior closing wedge osteotomy. Asian Spine J, 2014, 8(3):322-330.
24.	Ayberk G, Ozveren MF, Altundal N, et al. Three column stabilization through posterior approach alone:transpedicular placement of distractable cage with transpedicular screw fixation. Neurol Med Chir (Tokyo), 2008, 48(1):8-14.
25.	Sudo H, Ito M, Abumi K, et al. One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. Eur Spine J, 2010, 19(6):907-915.
26.	Omi H, Yokoyama T, Ono A, et al. Can MRI predict subsequent pseudarthrosis resulting from osteoporotic thoracolumbar vertebral fractures? Eur Spine J, 2014, 23(12):2705-2710.

1. Wong CC, McGirt MJ. Vertebral compression fractures:a review of current management and multimodal therapy. J Multidiscip Healthc, 2013, 6:205-214.
2. Galibert P, Deramond H, Rosat P, et al. Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie, 1987, 33(2):166-168.
3. 邹德威, 马华松, 邵水霖, 等. 球囊扩张椎体后凸成形术治疗老年骨质疏松脊柱压缩骨折. 中华骨科杂志, 2003, 23(5):257-261.
4. Suk SI, Kim JH, Lee SM, et al. Anteriorposterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine (Phila Pa 1976), 2003, 28(18):2170-2175.
5. Sasani M, Ozer AF. Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine (Phila Pa 1976), 2009, 34(1):E33-40.
6. Rzewuska M, Ferreira M, McLachlan AJ, et al. The efficacy of conservative treatment of osteoporotic compression fractures on acute pain relief:a systematic review with meta-analysis. Eur Spine J, 2015, 24(4):702-714.
7. Bouza C, López-Cuadrado T, Almendro N, et al. Safety of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures in Europe:a meta-analysis of randomized controlled trials. Eur Spine J, 2015, 24(4):715-723.
8. Ensrud KE, Schousboe JT. Clinical practice. Vertebral fractures. N Engl J Med, 2011, 364(17):1634-1642.
9. Kempisky WH, Morgan PP, Boniface WR. Osteoporosis kyphosis with paraplegia. Neurology, 1958, 8(3):181-186.
10. Lee YL, Yip KM. The osteoporosis spine. Clin Orthop Relat Res, 1996, (323):91-97.
11. Shikata J, Yamamuro T, Iida H, et al. Surgical treatment for paraplegia resulting from vertebral fractures in senile osteoporosis. Spine (Phila Pa 1976), 1990, 15(6):485-489.
12. Kaneda K, Asano S, Hashimoto T, et al. The treatment of osteoporotic posttraumatic vertebral collapse using the Kaneda device and bioactive ceramic vertebral prosthesis. Spine (Phila Pa 1976), 1992, 17(8 Suppl):S295-303.
13. Suk SI, Kim JH, Lee SM, et al. Anteriorposterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture. Spine (Phila Pa 1976), 2003, 28(18):2170-2175.
14. Metcalfe S, Gbejuade H, Patel NR. The posterior transpedicular approach for circumferential decompression and instrumented stabilization with titanium cage vertebrectomy reconstruction for spinal tumors. Spine (Phila Pa 1976), 2012, 37(16):1375-1383.
15. Burval DJ, McLain RF, Milks R, et al. Primary pedicle screw augmentation in osteoporotic lumbar vertebrae:biomechanical analysis of pedicle fixation strength. Spine (Phila Pa 1976), 2007, 32(10):1077-1083.
16. 薛海滨, 马远征, 王亮, 等. 骨水泥加强椎弓根螺钉内固定治疗伴骨质疏松症的腰椎退行性病变. 中国骨质疏松杂志, 2011, 17(1):24-27, 34.
17. 赵洪普, 徐秋玉, 吕玉明, 等. 膨胀式椎弓根钉系统治疗椎体骨质疏松性骨折. 中国矫形外科杂志, 2012, 20(14):1265-1267.
18. Cho W, Cho SK, Wu C. The biomechanics of pedicle screw-based instrumentation. J Bone Joint Surg (Br), 2010, 92(8):1061-1065.
19. Patil S, Rawall S, Singh D, et al. Surgical patterns in osteoporotic vertebral compression fractures. Eur Spine J, 2013, 22(4):883-891.
20. Uchida K, Kobayashi S, Matsuzaki M, et al. Anterior versus posterior surgery for osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine. Eur Spine J, 2006, 15(12):1759-1767.
21. Okuda S, Oda T, Yamasaki R, et al. Surgical outcomes of osteoporotic vertebral collapse:a retrospective study of anterior spinal fusion and pedicle substraction osteotomy. Global Spine J, 2012, 2(4):221-226.
22. Rawall S, Singh D, Mohan K, et al. Surgical patterns in osteoporotic vertebral compression fractures. Eur Spine J, 2013, 22(4):883-891.
23. Takenaka S, Mukai Y, Hosono N, et al. Major surgical treatment of osteoporotic vertebral fractures in the elderly:a comparison of anterior spinal fusion, anterior-posterior combined surgery and posterior closing wedge osteotomy. Asian Spine J, 2014, 8(3):322-330.
24. Ayberk G, Ozveren MF, Altundal N, et al. Three column stabilization through posterior approach alone:transpedicular placement of distractable cage with transpedicular screw fixation. Neurol Med Chir (Tokyo), 2008, 48(1):8-14.
25. Sudo H, Ito M, Abumi K, et al. One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. Eur Spine J, 2010, 19(6):907-915.
26. Omi H, Yokoyama T, Ono A, et al. Can MRI predict subsequent pseudarthrosis resulting from osteoporotic thoracolumbar vertebral fractures? Eur Spine J, 2014, 23(12):2705-2710.

Chinese Journal of Reparative and Reconstructive Surgery

PEDICLE SUBTRACTION OSTEOTOMY ASSISTED WITH ANTERIOR COLUMN RECONSTRUCTION FOR TREATMENT OF CHRONIC OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURE

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