Treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis by transintervertebral release, bone impaction grafting, and posterior column compressed-closing_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Wenqiang ,  YU Haiyang , LIANG Chengmin , ZHAI Yunlei , CUI Xilong , WANG Wei , ZHANG Wei

Department of Orthopaedics, Fuyang Clinical College, Anhui Medical University, Fuyang Anhui, 236000, P. R. China;

Corresponding author：

YU Haiyang, Email: fy.yhy@163.com

Keywords：

Spine fracture; intervertebral release; osteoporosis; bone impaction grafting; kyphosis

DOI：

10.7507/1002-1892.201905009

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To explore the safety and preliminary effectiveness of transintervertebral release, bone impaction grafting, and posterior column compressed-closing in the treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis.Methods The clinical data of 21 elderly patients with osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis were retrospectively analyzed between March 2016 and November 2017. There were 1 male and 20 females, aged 55-75 years, with an average of 64.8 years. The disease duration was 8-24 months, with an average of 13.1 months. The bone density T value ranged from −3.4 to −2.1, with an average of −2.3. Lesion segments: T₁₁ in 2 cases, T₁₂ in 6 cases, L₁ in 8 cases, L₂ in 1 case, T_{11, 12} in 1 case, T₁₂, L₁ in 2 cases, and T₁₂, L₂ in 1 case. Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA): 5 cases of grade D and 16 cases of grade E. All patients underwent transintervertebral release, bone impaction grafting, and posterior column compressed-closing. The effectiveness was evaluated by visual analogue scale (VAS) score and Oswestry dysfunction index (ODI) score before operation, at 3 months after operation, and at last follow-up. The neurological function was assessed by ASIA at last follow-up. Local kyphosis Cobb angle (LKCA), thoracic kyphosis (TK), lumbar lordosis (LL), and sagittal vertebral axis (SVA) were measured on the X-ray films of the full-length lateral spine of the patient before operation, at 1 week after operation, and at last follow-up.Results No complication such as fracture of internal fixator or nerve injury occurred. LKCA, TK, and SVA were significantly improved at 1 week after operation and at last follow-up (P<0.05). There was no significant difference between at 1 week after operation and at last follow-up (P>0.05). There was no significant difference in LL before and after operation (F=3.013, P=0.057). The VAS and ODI scores were significantly improved at 3 months after operation and at last follow-up, and further improved at last follow-up when compared with the scores at 3 months after operation, showing significant differences between time points (P<0.05). Five patients with ASIA grade D neurological function recovered to grade E at 6 months after operation.Conclusion Transintervertebral release, bone impaction grafting, and posterior column compressed-closing for treating osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis has definite effectiveness, strong orthopaedic ability, and minimal trauma, which can effectively restore the sagittal balance of the spine, alleviate pain, and improve the patients’ quality of life.

Citation： XU Wenqiang, YU Haiyang, LIANG Chengmin, ZHAI Yunlei, CUI Xilong, WANG Wei, ZHANG Wei. Treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis by transintervertebral release, bone impaction grafting, and posterior column compressed-closing. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(11): 1406-1413. doi: 10.7507/1002-1892.201905009 Copy

1.	Sudo H, Ito M, Abumi K, et al. One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. Eur Spine J, 2010, 19(6): 907-915.
2.	Dorward IG, Lenke LG. Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review. Neurosurg Focus, 2010, 28(3): E4.
3.	Picazo DR, Villaescusa JR, Martínez EP, et al. Late collapse osteoporotic vertebral fracture in an elderly patient with neurological compromise. Eur Spine J, 2014, 23(12): 2696-2702.
4.	杨德顺, 雷丙俊, 廖亮, 等. 改良推管在单侧椎弓根穿刺经皮椎体后凸成形术的应用. 中国修复重建外科杂志, 2017, 31(2): 197-202.
5.	Grevitt M, Kamath V, Avadhani A, et al. Correction of thoracic kyphosis with Ponte osteotomy. Eur Spine J, 2010, 19(2): 351-352.
6.	Hu X, Thapa AJ, Cai Z, et al. Comparison of smith-petersen osteotomy, pedicular subtraction osteotomy, and poly-segmental wedge osteotomy in treating rigid thoracolumbar kyphotic deformity in ankylosing spondylitis a systematic review and meta-analysis. BMC Surg, 2016, 16: 4.
7.	Lazennec JY, Neves N, Rousseau MA, et al. Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels. J Spinal Disord Tech, 2006, 19(7): 487-494.
8.	李青松, 刘少喻, 尹宗生. 多节段腰椎后路椎体间及后外侧融合椎弓根螺钉内固定治疗老年骨质疏松骨折合并胸腰椎后凸畸形. 中国组织工程研究, 2019, 23(4): 512-517.
9.	Suk SI, Kim JH, Kim WJ, et al. Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976), 2002, 27(21): 2374-2382.
10.	Lü G, Wang B, Li Y, et al. Posterior vertebral column resection and intraoperative manual traction to correct severe post-tubercular rigid spinal deformities incurred during childhood: minimum 2-year follow-up. Eur Spine J, 2015, 24(3): 586-593.
11.	张旭, 于海洋, 梁成民, 等. 俯卧位脊柱全长加压CT检查在骨质疏松性脊柱骨折伴后凸畸形治疗中的作用. 中国脊柱脊髓杂志, 2018, 28(6): 516-521.
12.	Bayliss M, Miltenburger C, White M, et al. A conceptual and disease model framework for osteoporotic kyphosis. Osteoporos Int, 2013, 24(9): 2423-2432.
13.	Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976), 2005, 30(18): 2024-2029.
14.	刘辰君, 朱震奇, 段硕, 等. 退变性胸腰交界区后凸及其矢状位平衡代偿机制的影像学分析. 中国脊柱脊髓杂志, 2018, 28(2): 158-163.
15.	Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between Smith-Petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2012, 25(7): 383-390.
16.	Januszewski J, Beckman JM, Harris JE, et al. Biomechanical study of rod stress after pedicle subtraction osteotomy versus anterior column reconstruction: A finite element study. Surg Neurol Int, 2017, 8: 207.
17.	金志辉, 方洪松, 陈森, 等. Ⅳ级截骨术在椎间盘组织嵌入椎体陈旧性胸腰椎骨折并后凸畸形手术治疗中的应用. 中国骨与关节损伤杂志, 2019, 34(3): 237-240.
18.	Kawahara N, Tomita K, Baba H, et al. Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine (Phila Pa 1976), 2001, 26(4): 391-402.
19.	齐强, 陈仲强, 郭昭庆, 等. 脊柱前方垫高-后方闭合截骨矫形术治疗胸腰段脊柱后凸畸形的初步报告. 中华外科杂志, 2006, 44(8): 551-555.
20.	张国华, 杜旻育, 陈鸿昌, 等. 顶椎前凸截骨术治疗胸椎或胸腰段骨质疏松性驼背畸形. 中国脊柱脊髓杂志, 2006, 16(8): 571-575.
21.	Kuhns CA, Reiter M, Pfeiffer F, et al. Surgical strategies to improve fixation in the osteoporotic spine: the effects of tapping, cement augmentation, and screw trajectory. Global Spine J, 2014, 4(1): 47-54.
22.	Yang S, Liu Y, Yang H, et al. Risk factors and correlation of secondary adjacent vertebral compression fracture in percutaneous kyphoplasty. Int J Surg, 2016, 36(Pt A): 138-142.
23.	Gazzeri R, Roperto R, Fiore C. Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study. J Neurosurg Spine, 2016, 25(5): 610-619.
24.	张银昌, 赵清华, 秦晓东, 等. SRS-Schwab Ⅳ 级截骨联合卫星棒技术治疗胸腰椎陈旧性骨质疏松性骨折伴严重后凸畸形. 中国修复重建外科杂志, 2019, 33(3): 259-264.

1. Sudo H, Ito M, Abumi K, et al. One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neurological deficits. Eur Spine J, 2010, 19(6): 907-915.
2. Dorward IG, Lenke LG. Osteotomies in the posterior-only treatment of complex adult spinal deformity: a comparative review. Neurosurg Focus, 2010, 28(3): E4.
3. Picazo DR, Villaescusa JR, Martínez EP, et al. Late collapse osteoporotic vertebral fracture in an elderly patient with neurological compromise. Eur Spine J, 2014, 23(12): 2696-2702.
4. 杨德顺, 雷丙俊, 廖亮, 等. 改良推管在单侧椎弓根穿刺经皮椎体后凸成形术的应用. 中国修复重建外科杂志, 2017, 31(2): 197-202.
5. Grevitt M, Kamath V, Avadhani A, et al. Correction of thoracic kyphosis with Ponte osteotomy. Eur Spine J, 2010, 19(2): 351-352.
6. Hu X, Thapa AJ, Cai Z, et al. Comparison of smith-petersen osteotomy, pedicular subtraction osteotomy, and poly-segmental wedge osteotomy in treating rigid thoracolumbar kyphotic deformity in ankylosing spondylitis a systematic review and meta-analysis. BMC Surg, 2016, 16: 4.
7. Lazennec JY, Neves N, Rousseau MA, et al. Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels. J Spinal Disord Tech, 2006, 19(7): 487-494.
8. 李青松, 刘少喻, 尹宗生. 多节段腰椎后路椎体间及后外侧融合椎弓根螺钉内固定治疗老年骨质疏松骨折合并胸腰椎后凸畸形. 中国组织工程研究, 2019, 23(4): 512-517.
9. Suk SI, Kim JH, Kim WJ, et al. Posterior vertebral column resection for severe spinal deformities. Spine (Phila Pa 1976), 2002, 27(21): 2374-2382.
10. Lü G, Wang B, Li Y, et al. Posterior vertebral column resection and intraoperative manual traction to correct severe post-tubercular rigid spinal deformities incurred during childhood: minimum 2-year follow-up. Eur Spine J, 2015, 24(3): 586-593.
11. 张旭, 于海洋, 梁成民, 等. 俯卧位脊柱全长加压CT检查在骨质疏松性脊柱骨折伴后凸畸形治疗中的作用. 中国脊柱脊髓杂志, 2018, 28(6): 516-521.
12. Bayliss M, Miltenburger C, White M, et al. A conceptual and disease model framework for osteoporotic kyphosis. Osteoporos Int, 2013, 24(9): 2423-2432.
13. Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976), 2005, 30(18): 2024-2029.
14. 刘辰君, 朱震奇, 段硕, 等. 退变性胸腰交界区后凸及其矢状位平衡代偿机制的影像学分析. 中国脊柱脊髓杂志, 2018, 28(2): 158-163.
15. Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between Smith-Petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2012, 25(7): 383-390.
16. Januszewski J, Beckman JM, Harris JE, et al. Biomechanical study of rod stress after pedicle subtraction osteotomy versus anterior column reconstruction: A finite element study. Surg Neurol Int, 2017, 8: 207.
17. 金志辉, 方洪松, 陈森, 等. Ⅳ级截骨术在椎间盘组织嵌入椎体陈旧性胸腰椎骨折并后凸畸形手术治疗中的应用. 中国骨与关节损伤杂志, 2019, 34(3): 237-240.
18. Kawahara N, Tomita K, Baba H, et al. Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine (Phila Pa 1976), 2001, 26(4): 391-402.
19. 齐强, 陈仲强, 郭昭庆, 等. 脊柱前方垫高-后方闭合截骨矫形术治疗胸腰段脊柱后凸畸形的初步报告. 中华外科杂志, 2006, 44(8): 551-555.
20. 张国华, 杜旻育, 陈鸿昌, 等. 顶椎前凸截骨术治疗胸椎或胸腰段骨质疏松性驼背畸形. 中国脊柱脊髓杂志, 2006, 16(8): 571-575.
21. Kuhns CA, Reiter M, Pfeiffer F, et al. Surgical strategies to improve fixation in the osteoporotic spine: the effects of tapping, cement augmentation, and screw trajectory. Global Spine J, 2014, 4(1): 47-54.
22. Yang S, Liu Y, Yang H, et al. Risk factors and correlation of secondary adjacent vertebral compression fracture in percutaneous kyphoplasty. Int J Surg, 2016, 36(Pt A): 138-142.
23. Gazzeri R, Roperto R, Fiore C. Surgical treatment of degenerative and traumatic spinal diseases with expandable screws in patients with osteoporosis: 2-year follow-up clinical study. J Neurosurg Spine, 2016, 25(5): 610-619.
24. 张银昌, 赵清华, 秦晓东, 等. SRS-Schwab Ⅳ 级截骨联合卫星棒技术治疗胸腰椎陈旧性骨质疏松性骨折伴严重后凸畸形. 中国修复重建外科杂志, 2019, 33(3): 259-264.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of osteoporotic vertebral fracture combined with moderate to severe spinal kyphosis by transintervertebral release, bone impaction grafting, and posterior column compressed-closing

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content