Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures

Abstract

Study Design Technical report. Objective Multilevel osteoporotic vertebral compression fractures may lead to considerable thoracic deformity and sagittal imbalance, which may necessitate surgical intervention. Correction of advanced thoracic kyphosis in patients with severe osteoporosis remains challenging, with a high rate of failure. This study describes a surgical technique of staged vertebral augmentation with osteotomies for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures. Methods Five patients (average age 62 ± 6 years) with multilevel osteoporotic vertebral compression fractures and severe symptomatic thoracic kyphosis underwent staged vertebral augmentation and surgical correction of their sagittal deformity. Clinical and radiographic outcomes were assessed retrospectively at a mean postoperative follow-up of 34 months. Results Patients' self-reported back pain decreased from 7.2 ± 0.8 to 3.0 ± 0.7 (0 to 10 numerical scale; p < 0.001). Patients' back-related disability decreased from 60 ± 10% to 29 ± 10% (0 to 100% Oswestry Disability Index; p < 0.001). Thoracic kyphosis was corrected from 89 ± 5 degrees to 40 ± 4 degrees (p < 0.001), and the sagittal vertical axis was corrected from 112 ± 83 mm to 38 ± 23 mm (p = 0.058). One patient had cement leakage without subsequent neurologic deficit. Decreased blood pressure was observed in another patient during the cement injection. No correction loss, hardware failure, or neurologic deficiency was seen in the other patients. Conclusion The surgical technique described here, despite its complexity, may offer a safe and effective method for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures.

Paraspinal myopathy-induced intervertebral disc degeneration and thoracolumbar kyphosis in TSC1mKO mice model—a preliminary study

“…Therefore, myopathy-induced vertebral body wedging and osteoporosis are likely two independent processes that occurs with aging. The absence of vertebral fractures also ruled out the possibility of fragility fracture as a confounder for spinal kyphosis in the TSC1mKO mice model (48,49). Nevertheless, bony changes which appeared only at 12 months is likely a delayed process contributing to late-stage spinal kyphosis.…”

Planned two-stage surgery using lateral lumbar interbody fusion and posterior corrective fusion: a retrospective study of perioperative complications

“…Notably, the surgical targets in this study had almost the same demographic characteristics, comorbidities, spinopelvic parameters, and PROMs before surgery. Planned two-stage surgery has been performed for various complex spinal deformities [13][14][15][16]. Perioperative complication rates are high for surgical procedures that involve a long operating time and substantial blood loss.…”

Osteoporotic Thoracolumbar Vertebral Fractures With Neurological Deficit Treated by Balloon Kyphoplasty Augmented with Newly Developed Minimally Invasive Posterior Hook Stabilization

“…pedicle subtraction osteotomy), and vertebroplasty with posterior spinal fusion [ 4 - 6 ]; however, the substantial surgical invasion involved remains an issue. Multiple OVFs can also cause severe sagittal imbalances and require surgical intervention [ 7 ].…”