Five-year follow up results of posterior decompression and fixation surgery for delayed neural disorder associated with osteoporotic vertebral fracture

Yasuda, Taketoshi; Kawaguchi, Yoshiharu; Suzuki, Kayo; Nakano, Masato; Seki, Shoji; Watabnabe, Kenta; Koike, Masahiko; Kimura, Takeshi

doi:10.1097/md.0000000000009395

Cited by 13 publications

(9 citation statements)

References 21 publications

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“…Thus, the beneficial effect of a persistent restoration of the vertebral height on the sagittal alignment might be even more pronounced in the midthoracic spine based on the smaller intervertebral discs. In accordance to that, the mean loss of reduction seen in our patients was in the lower range in comparison to literature which ranged between 4.6 ° and 23° [ 6 , 29 – 31 ].…”

Section: Discussionsupporting

confidence: 89%

Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly

Spiegl¹,

Hölbing²,

Jarvers³

et al. 2021

BMC Musculoskelet Disord

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Background The evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly. Methods Retrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization and long-segmental stabilization. Results Fifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n = 38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03). Conclusion Unstable fractures of the midthoracic spine are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with long segmental stabilization had a significantly lower rate of sequential vertebral body fractures during follow-up.

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Section: Discussionsupporting

confidence: 89%

Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly

Spiegl¹,

Hölbing²,

Jarvers³

et al. 2021

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Thus, the bene cial effect of a persistent restoration of the vertebral height on the sagittal alignment might be even more pronounced in the midthoracic spine based on the smaller intervertebral discs. In accordance to that, the mean loss of reduction seen in our patient collective was in the lower range in comparison to literature which ranged between 4.6 and 23° [6,[29][30][31].…”

Section: Discussionsupporting

confidence: 88%

Midterm Outcome after Posterior Stabilization of Unstable Midthoracic Spine Fractures in the Elderly

Spiegl

Hölbing

Jarvers

et al. 2020

Preprint

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Background: The evidence for the treatment of midthoracic fractures in elderly patients is weak. The aim of this study was to evaluate midterm results after posterior stabilization of unstable midthoracic fractures in the elderly.Methods: Retrospectively, all patients aged ≥65 suffering from an acute unstable midthoracic fracture treated with posterior stabilization were included. Trauma mechanism, ASA score, concomitant injuries, ODI score and radiographic loss of reduction were evaluated. Posterior stabilization strategy was divided into short-segmental stabilization (SSS) and long-segmental stabilization (LSS). Results: Fifty-nine patients (76.9 ± 6.3 years; 51% female) were included. The fracture was caused by a low-energy trauma mechanism in 22 patients (35.6%). Twenty-one patients died during the follow-up period (35.6%). Remaining patients (n=38) were followed up after a mean of 60 months. Patients who died were significantly older (p = 0.01) and had significantly higher ASA scores (p = 0.02). Adjacent thoracic cage fractures had no effect on mortality or outcome scores. A total of 12 sequential vertebral fractures occurred (35.3%). The mean ODI at the latest follow up was 31.3 ± 24.7, the mean regional sagittal loss of reduction was 5.1° (± 4.0). Patients treated with LSS had a significantly lower rate of sequential vertebral fractures during follow-up (p = 0.03). Conclusion: Unstable fractures of the midthoracic are associated with high rates of thoracic cage injuries. The mortality rate was rather high. The majority of the survivors had minimal to moderate disabilities. Thereby, patients treated with LSS had a significantly lower rate of sequential vertebral body fractures during follow-up.

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“…Clinical courses were evaluated using the Japanese Orthopaedic Association (JOA) scores at 3 months, 6 months, and 1 year after surgery (Table 3 ) [ 19 ]. Briefly, subjective symptoms (9 points: low back pain, leg pain, and walking ability), clinical signs (6 points: sensory and motor disturbance and positive straight leg raise test results), and activities of daily living (ADL, 14 points) were evaluated.…”

Section: Methodsmentioning

confidence: 99%

Clinical and imaging characteristics in patients undergoing surgery for lumbar epidural lipomatosis

Yasuda

Suzuki

Kawaguchi

et al. 2018

BMC Musculoskelet Disord

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BackgroundLumbar epidural lipomatosis (LEL) is characterized by abnormal accumulation of unencapsulated adipose tissue in the spinal epidural space. Such accumulation compresses the dural sac and nerve roots, and results in various neurological findings. However, the pathophysiology of LEL remains unclear. This study examined the associations between imaging and clinical findings in detail, and investigated the mechanisms underlying symptom onset by measuring intraoperative epidural pressures in LEL.MethodsSixteen patients (all men; mean age, 68.8 years) were enrolled between 2011 and 2015. Mean body mass index was 26.5 kg/m2. Four cases were steroid-induced, and the remaining 12 cases were idiopathic. All patients presented with neurological deficits in the lower extremities. Cauda equina syndrome (CES) alone was seen in 8 patients, radiculopathy alone in 4, and both radiculopathy and CES (mixed CES) in 4. All patients subsequently underwent laminectomy with epidural lipomatosis resection and were followed-up for more than 1 year. We investigated the clinical course and imaging and measured epidural pressures during surgery.ResultsSubjective symptoms improved within 1 week after surgery. Mean Japanese Orthopaedic Association (JOA) score was 15.2 ± 2.8 before surgery, improving to 25.4 ± 2.5 at 1 year after surgery. On magnetic resonance imaging, all lipomatosis lesions included the L4–5 level. On preoperative computed tomography, saucerization of the laminae was not observed in radiculopathy cases, whereas saucerization of the posterior vertebral body was observed in all radiculopathy or mixed CES cases. Intraoperative epidural pressures were significantly higher than preoperative subarachnoid pressures. The results suggest that high epidural pressure resulting from the proliferation of adipose tissue leads to saucerization of the lumbar spine and subsequent symptoms.ConclusionsClinical courses were satisfactory after laminectomy. In LEL, epidural pressure increases and symptoms develop through the abnormal proliferation of adipose tissue. Higher epidural pressures induce saucerization of the laminae and/or posterior vertebral body. Furthermore, the direction of proliferative adipose tissue (i.e., site of saucerization) might be related to the types of neurological symptoms.

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Five-year follow up results of posterior decompression and fixation surgery for delayed neural disorder associated with osteoporotic vertebral fracture

Cited by 13 publications

References 21 publications

Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly

Midterm outcome after posterior stabilization of unstable Midthoracic spine fractures in the elderly

Midterm Outcome after Posterior Stabilization of Unstable Midthoracic Spine Fractures in the Elderly

Clinical and imaging characteristics in patients undergoing surgery for lumbar epidural lipomatosis

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