A short-segment fusion strategy using a wide-foot-plate expandable cage for vertebral pseudarthrosis after an osteoporotic vertebral fracture

Abstract

OBJECTIVEVarious surgical treatments have been reported for vertebral pseudarthrosis after osteoporotic vertebral fracture (OVF). However, the outcomes are not always good. The authors now have some experience with combined anterior-posterior short-segment spinal fusion (1 level above and 1 level below the fracture) using a wide-foot-plate expandable cage. Here, they report their surgical outcomes with this procedure.METHODSBetween June 2016 and August 2018, 16 consecutive patients (4 male and 12 female; mean age 75.1 years) underwent short-segment spinal fusion for vertebral pseudarthrosis or delayed collapse after OVF. The mean observation period was 20.1 months. The level of the fractured vertebra was T12 in 4 patients, L1 in 3, L2 in 4, L3 in 3, and L4 in 2. Clinical outcomes were assessed using the lumbar Japanese Orthopaedic Association (JOA) scale and 100-mm visual analog scale for low-back pain. Local kyphotic angle, intervertebral height, bone union rate, and instrumentation-related adverse events were investigated as imaging outcomes. The data were analyzed using the Wilcoxon signed-rank test.RESULTSThe mean operating time was 334.3 minutes (range 256–517 minutes), and the mean blood loss was 424.9 ml (range 30–1320 ml). The only perioperative complication was a superficial infection of the posterior wound that was cured by irrigation. The lumbar JOA score and visual analog scale value improved from 11.2 and 58.8 mm preoperatively to 20.6 and 18.6 mm postoperatively, respectively. The mean local kyphotic angle and mean intervertebral height were 22.6° and 28.0 mm, respectively, before surgery, −1.5° and 40.5 mm immediately after surgery, and 7.0° and 37.1 mm at the final observation. Significant improvement was observed in both parameters immediately after surgery and at the final observation when compared with the preoperative values. Intraoperative endplate injury occurred in 8 cases, and progression of cage subsidence of 5 mm or more was observed in 2 of these cases. Proximal junctional kyphosis was observed in 2 cases. There were no cases of screw loosening. No cases required reoperation due to instrument-related adverse events. Bone union was observed in all 14 cases that had CT evaluation.CONCLUSIONSThis short-segment fusion procedure is relatively minimally invasive, and local reconstruction and bone fusion have been achieved. This procedure is considered to be attempted for the surgical treatment of osteoporotic vertebral pseudarthrosis after OVF.

Radiological Evaluation of Combined Anteroposterior Fusion with Vertebral Body Replacement Using a Minimally Invasive Lateral Approach for Osteoporotic Vertebral Fractures: Verification of Optimal Surgical Procedure

“…Taiji et al reported a result of a similar procedure in 16 OVF patients and reported that the average correction loss angle was 8.5 • with one above-one below fusion [24]. The average correction loss angle in our study was 12.3 • for less than two above-two below fixation, which was larger than the study by Taiji. In their study, lamina hooks were used combined with pedicle screws, and in the patients whose kyphosis was unable to be corrected at prone position, anterior release was initially performed followed by P-A surgery, which required the patient's position to be changed twice during surgery.…”

“…Recently, the widespread use of minimally invasive spinal treatment (MIST) has made it possible to perform combined anteroposterior fusion with vertebral body replacement (VBR) using a wide footplate expandable cage with a minimally invasive lateral approach [24,25]. The anterior surgical approach can be performed in the same way as the minimally invasive lumbar-lateral interbody fusion (L-LIF) approach, and corpectomy can achieve a fixation with less adjacent tissue damage [26].…”

Differences in surgical outcome after anterior corpectomy and reconstruction with an expandable cage with rectangular footplates between thoracolumbar and lumbar osteoporotic vertebral fracture

“…Diminution and residual VAS at final follow-up were almost the same as results previously reported for OVF surgeries, including VP/BKP. [ 5 , 27 , 39 ] As for performance status, nearly 90% of patients improved by more than 1 level after surgery, with no significant difference between groups. However, the JOA score improvement ratio was significantly better in the L group (60.0%) than in the TL group (46.9%; p<0.05).…”

Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture

“…Moreover, instead of a conventional cage with a cylindrical footplate, a large rectangular footplate cage that provides coverage as wide as the vertebral endplate diameter, which may improve the mechanical supportability of the cage [ 15 , 16 ] and reduce correction losses, can be used in this surgical approach, even in patients with osteoporosis. Some surgical results have been reported [ 17 ]; however, due to the lack of comparison with the conventional anterior approach using a cylindrical cage, the effectiveness of LAVR for OVF continues to be debated.…”