Posterior Spinal Shortening for Paraplegia After Vertebral Collapse Caused by Osteoporosis

Saita, Kazuo; Hoshino, Yuichi; Kikkawa, Ichiro; Nakamura, Hitoshi

doi:10.1097/00007632-200011010-00018

Cited by 81 publications

(59 citation statements)

References 15 publications

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“…To date, controversies still prevail regarding terminology, pathogenesis, and treatment of this condition. Accordingly, a variety of surgical procedures have been reported, including osteosynthesis [5], decompression and fusion surgeries by anterior [6,7], posterior [7][8][9], and anteroposterior [10] approaches, percutaneous vertebroplasty (PVP) [11][12][13], and percutaneous kyphoplasty [14]. Whereas osteosynthesis and fusion surgeries aim at solid bone union for stabilization of the affected vertebra, union status following PVP or percutaneous kyphoplasty has not yet been addressed.…”

Section: Introductionmentioning

confidence: 99%

Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

et al. 2010

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To determine the role of percutaneous vertebroplasty (PVP) in bone formation and the union of vertebral pseudarthrosis, we analyzed 14 patients with an average follow-up duration of 21 months. Evaluation methods included back pain (visual analog scale: VAS), wedge angle, dynamic mobility, radiographic remodeling including callus and spur formation, and union status. The Student's t test was used for statistical analysis and a probability of less than 0.05 was determined as a significant difference. Back pain improved in all 14 patients with a VAS score of 57.8 ± 23.5 mm (average ± standard deviation) preoperatively and 14.7 ± 16.4 mm at the final follow-up (P \ 0.001). The wedge angle decreased from 21.6°± 8.3°(average ± standard deviation) preoperatively to 13.2°± 6.9°at the final follow-up (P \ 0.001). Callus formation was seen in four patients. Bony spurs were seen in the affected vertebra in preoperative radiographs in all patients, and were further developed to a solidified form during follow up after PVP. Dynamic mobility of the affected vertebrae was 6.9 ± 2.9 mm preoperatively, which decreased to 1.1°± 0.7°at the final follow-up (P \ 0.001). Notably, all patients showed the dynamic vertebral mobility of 2 mm or less. Nevertheless, only two patients exhibited the dynamic vertebral mobility of 0 mm at the final follow-up, which is referred to as bone union. These findings indicate that PVP serves as a mechanical stabilizer for vertebral pseudarthrosis, which leads to immediate pain relief and segmental bony responses.

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Section: Introductionmentioning

confidence: 99%

Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

et al. 2010

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“…Surgical procedures include resection of fractured vertebral bodies and grafting of autologous bone with implants through the anterior approach are one option, while closed-wedge osteotomy through the posterior approach has been another [9,20,25,27]. However, considering the age and comorbidities of affected patients, each of these procedures is rather invasive.…”

Section: Introductionmentioning

confidence: 99%

Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture

et al. 2009

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The purpose of this study was to examine factors affecting the severity of neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture (OVF). Reports of insufficient union following OVF have recently increased. Patients with this lesion have various degrees of neurological deficits and back pain. However, the factors contributing to the severity of these are still unknown. A total of 45 patients with insufficient union following OVF were included in this study. Insufficient union was diagnosed based on the findings of vertebral cleft on plain radiography or CT, as well as fluid collection indicating high-intensity change on T2-weighted MRI. Multivariate logistic regression analysis was performed to determine the factors contributing to the severity of neurological deficits and back pain in the patients. Age, sex, level of fracture, duration after onset of symptoms, degree of local kyphosis, degree of angular instability, ratio of occupation by bony fragments, presence or absence of protrusion of flavum, and presence or absence of ossification of the anterior longitudinal ligament (OALL) in the adjacent level were used as explanatory variables, while severity of neurological deficits and back pain were response variables. On multivariate analysis, factors significantly affecting the severity of neurological deficits were angular instability of more than 15°[adjusted odds ratio (OR), 9.24 (95% confidence interval, CI 1.49-57.2); P \ 0.05] and ratio of occupation by bony fragments in the spinal canal of more than 42% [adjusted OR 9.23 (95%CI 1.15-74.1); P \ 0.05]. The factor significantly affecting the severity of back pain was angular instability of more than 15°[ adjusted OR 14.9 (95%CI 2.11-105); P \ 0.01]. On the other hand, presence of OALL in the adjacent level reduced degree of back pain [adjusted OR 0.14 (95%CI 0.03-0.76); P \ 0.05]. In this study, pronounced angular instability and marked posterior protrusion of bony fragments in the canal were factors affecting neurological deficits. In addition, marked angular instability was a factor affecting back pain. These findings are useful in determining treatment options for patients with insufficient union following OVF.

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“…12 In posterior spinal shortening as we propose it, the upper and lower spines are brought parallel by resecting and shortening posterior elements of a fractured vertebra to the same extent as anterior portions, allowing substantial reduction of kyphosis. Thus, thoracic spinal curvature nears straight, and the vector at which kyphosis is enhanced decreases even if the same load is placed on the thoracic spine ( Figure 1).…”

Section: Concept Of Posterior Spinal Shorteningmentioning

confidence: 98%

“…12 The vertical load placed on a backward-curved thoracic spine acts to enhance thoracic kyphosis. In cases with a compression fracture in particular, kyphosis intensifies from the beginning and kyphosisenhancing action increases the compression further.…”

Section: Mechanism Of Instrumentation Dislocationmentioning

confidence: 99%

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Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis

et al. 2007

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Study design: Retrospective case series. Objectives: To assess the efficacy of posterior spinal shortening for paraparetic patients following vertebral collapse owing to osteoporosis, especially on instrumentation loosening. Setting: Department of orthopaedic surgery, Jichi Medical University Hospital and Omiya Medical Center in Japan. Methods:The clinical records and radiographs of 13 patients with paraparesis following vertebral collapse owing to osteoporosis treated with posterior spinal shortening were retrospectively reviewed to evaluate the usefulness of this method. Assessment of the clinical course was done by direct examination in all cases. Ambulatory ability was divided into four categories. Results: Upon final observation, nine cases were able to walk with a cane or crutch, one case remained in gait training, two cases remained unable to stand and one case with urinary incontinence improved in urinary function. In one case, paralysis deteriorated. Vertebral compression fracture of the end vertebrae that were fixed occurred in three cases complicated with rheumatoid arthritis. Conclusion: The posterior spinal shortening can be a choice for treating delayed paraparesis following vertebral collapse owing to osteoporosis.

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Posterior Spinal Shortening for Paraplegia After Vertebral Collapse Caused by Osteoporosis

Abstract: The posterior spinal shortening can be a choice for treating delayed paraplegia after osteoporotic vertebral fracture.

Cited by 81 publications

References 15 publications

Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

Conversion to hypertrophic vertebral pseudarthrosis following percutaneous vertebroplasty

Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture

Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis

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