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

Abstract

The aim of the current study was to compare outcomes between lateral access vertebral reconstruction (LAVR) using a rectangular footplate cage and the conventional procedure using a cylindrical footplate cage in patients with osteoporotic vertebral fracture (OVF). We included 46 patients who underwent anterior–posterior combined surgery for OVF: 24 patients underwent LAVR (Group L) and 22 underwent the conventional procedure (Group C). Preoperative, postoperative, and 1- and 2-year follow-up X-ray images were used to measure local lordotic angle, correction loss, and cage subsidence (>2 mm in vertebral endplate depression). In anterior surgery, the operation time was significantly shorter (183 vs. 248 min, p < 0.001) and the blood loss was significantly less (148 vs. 406 mL, p = 0.01) in Group L than in Group C. In Group C, two patients had anterior instrumentation failure. Correction loss was significantly smaller in Group L than in Group C (1.9° vs. 4.9° at 1 year, p = 0.02; 2.5° vs. 6.5° at 2 years, p = 0.04, respectively). Cage subsidence was significantly less in Group L than in Group C (29% vs. 80%, p < 0.001). LAVR using a rectangular footplate cage is an effective treatment for OVF to minimize surgical invasiveness and postoperative correction loss.

A triple minimally invasive surgery combination for subacute osteoporotic lower lumbar vertebral collapse with neurological compromise: a potential alternative to the vertebral corpectomy/expandable cage strategy

“…If treating patients with osteoporosis using the corpectomy/expandable cage strategy, which allows for distraction to achieve correction of local kyphosis caused by the fracture, the surgeon may use supplemental PS fixation at the segments longer than 1 level above and below the fracture, even with a wide-footprint, expandable corpectomy cage. 11,12 The CT scans also revealed a progressive decrease in spinal canal compromise due to retropulsed vertebral body fragments, averaging 33.4% preoperatively, 28.9% postoperatively, and 23.1% at the latest evaluation. However, it remains unknown to what degree of severity in osseous retropulsion this strategy can continue to be effective.…”

“…2,7 To address this biomechanical need by using the minimally invasive surgery (MIS) techniques, several recent reports introduced corpectomy of the fractured vertebra, followed by expandable cage reconstruction via a mini-open, direct lateral approach on traumatic as well as osteoporotic burst fractures. [8][9][10][11][12][13][14][15][16] However, a negative aspect of this corpectomy/expandable cage strategy is that the corpectomy not only needs meticulous management of the segmental vessels overlying the fractured vertebral body, but also involves the technical challenge of removing the retropulsed fragments while controlling epidural bleeding. 8,9,[12][13][14][15] In addition, an expandable cage placed for reconstructing the corpectomy defect is subjected to a greater stress concentration as compared with a single-level cage at the interface between the cage footplate and the vertebral endplate.…”

“…Consequently, even with a wide-footprint expandable cage, corpectomy may require supplemental pedicle screw (PS) fixation at the segments longer than 1 level above and below the fracture in osteoporotic patients. 11,12 To circumvent these problems, Fukuda et al 17 more recently proposed to restore the anterior column not by using a corpectomy/expandable cage strategy but by the segmental MIS technique of oblique lateral interbody fusion [18][19][20] for lower lumbar OVCs. However, they added traditional open posterior procedures for decompression, autogenous local bone grafting, and PS placements.…”

Cage subsidence in anterior spinal reconstruction and its clinical outcomes following anterior and posterior stabilization in thoracolumbar fractures

“…Our research is consistent with previous studies regarding quality-of-life evaluations. In 2016, Theologis et al conducted a case-control study which revealed that patients with unstable lumbar burst fractures, who underwent corpectomy and anterior column reconstruction via a mini-open, extreme lateral, transpsoas approach with short-segment posterior xation, and were evaluated with the SF-12, had a physical health score of 42% and a mental health score of 50% [19]. Our results, on the other hand, demonstrate an even better quality-of-life, with an average physical health score of 55% and a mental health score of 59%.…”

Osteoporotic Vertebral Body Fractures: New Trends in Differential Diagnosis, Bracing and Surgery

“…Naoki Segi et al [ 3 ] retrospectively compared outcomes between MIS via an anterolateral approach (LAVR) using a rectangular footplate cage for vertebral reconstruction (Group L) and the conventional open anteroposterior surgery (group C) with a cylindrical footplate cage in patients aged >56 years suffering from osteoporotic fractures, neurological deficit, severe lower back pain, and pseudarthrosis. The authors showed that the rectangular footplate cage offers superior mechanical support that is derived from the footplate, while the rate of bony fusion was higher than in Group C. The authors underlined the differences that were found both in the fusion rate and fusion morphology.…”