Reduction of the domino effect in osteoporotic vertebral compression fractures through short-segment fixation with intravertebral expandable pillars compared to percutaneous kyphoplasty: a case control study

BMC Musculoskeletal Disorders

Po-Quang Chen³  Chui-Jia Farn¹  Hsuan-Yu Chen¹  Ting-Ming Wang¹  Chung-Ding Wu²  Jui-Yang Hsieh¹ 

[1] Department of Orthopedics, National Taiwan University & Hospital, No. 7, Chung-Shan South Rd., 100, Taipei, Taiwan;Department of Orthopaedics, Cathay General Hospital, No. 280, Sec. 4, Ren’ai Rd., Xinyi Dist., 110, Taipei City, Taiwan;Department of Orthopaedics, Min-Sheng General Hospital, 168, Jingguo Rd., 330, Taoyuan City, Taoyuan County, Taiwan

关键词: Vertebral compression fracture;    Percutaneous kyphoplasty;    Intravertebral expandable pillar;    Short-segment fixation;   

Others  :  1133935
DOI  :  10.1186/1471-2474-14-75

 received in 2012-05-31, accepted in 2013-02-21,  发布年份 2013

【 摘 要 】

Background

Osteoporotic vertebral compression fracture is the leading cause of disability and morbidity in elderly people. Treatment of this condition remains a challenge. Osteoporotic vertebral compression fractures can be managed with various approaches, but each has limitations. In this study, we compared the clinical outcomes obtained using short-segment fixation with intravertebral expandable pillars (I-VEP) to those obtained with percutaneous kyphoplasty in patients who had suffered vertebral compression fractures.

Methods

The study included 46 patients with single-level osteoporotic thoracolumbar fractures. Twenty-two patients in Group I underwent short-segment fixation with I-VEP and 24 patients in Group II underwent kyphoplasty. All patients were evaluated pre- and postoperatively using a visual analogue scale, anterior height of the fractured vertebra, and kyphotic angle of the fractured vertebra. The latter 2 radiological parameters were measured at the adjacent segments as well.

Results

There was no significant difference between the groups in terms of gender or fracture level, but the mean age was greater in Group II patients (p = 0.008). At the 1-year follow-up, there were no significant differences in the visual analogue scale scores, anterior height of the fractured vertebra, or the value representing anterior height above the fractured vertebra and kyphotic angle below the fractured vertebra, after adjusting for the patients’ gender, fracture level, and age. When considered separately, the anterior height below the fractured vertebra was significantly higher and the kyphotic angle above the fractured vertebra was significantly smaller in Group I than in Group II (p = 0.029 and p = 0.008, respectively). The kyphotic angle of the fractured vertebra was significantly smaller in Group II than in Group I (p < 0.001).

Conclusions

In older individuals with vertebral compression fractures, kyphoplasty restored and maintained the collapsed vertebral body with less kyphotic deformity than that induced by short-segment fixation with I-VEP. Short-segment fixation with I-VEP was more effective in maintaining the integrity of adjacent segments, which prevented the domino effect often observed in patients with osteoporotic kyphotic spines.

【 授权许可】

   
2013 Hsieh et al; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Andrade SE, Majumdar SR, Chan KA, Buist DS, Go AS, Goodman M, Smith DH, Platt R, Gurwitz JH: Low frequency of treatment of osteoporosis among postmenopausal women following a fracture. Arch Intern Med 2003, 163:2052-2057.
• [2]Korovessis P, Repantis T, Miller LE, Block JE: Initial clinical experience with a novel vertebral augmentation system for treatment of symptomatic vertebral compression fractures: a case series of 26 consecutive patients. BMC Musculoskelet Disord 2011, 12:206. BioMed Central Full Text
• [3]Majd ME, Farley S, Holt RT: Preliminary outcomes and efficacy of the first 360 consecutive kyphoplasties for the treatment of painful osteoporotic vertebral compression fractures. Spine J 2005, 5:244-255.
• [4]Syed MI, Jan S, Patel NA, Shaikh A, Marsh RA, Stewart RV: Fatal fat embolism after vertebroplasty: identification of the high-risk patient. AJNR Am J Neuroradiol 2006, 27:343-345.
• [5]Wu MH, Huang TJ, Li YY, Hsu RW: Role of the supine lateral radiograph of the spine in vertebroplasty for osteoporotic vertebral compression fracture: a prospective study. BMC Musculoskelet Disord 2010, 11:164. BioMed Central Full Text
• [6]Harrington KD: Major neurological complications following percutaneous vertebroplasty with polymethylmethacrylate: a case report. J Bone Joint Surg Am 2001, 83:1070-1073.
• [7]Chen JK, Lee HM, Shih JT, Hung ST: Combined extraforaminal and intradiscal cement leakage following percutaneous vertebroplasty. Spine 2007, 32:E358-E362.
• [8]Laredo JD, Hamze B: Complications of percutaneous vertebroplasty and their prevention. Skelet Radiol 2004, 33:493-505.
• [9]Korovessis P, Zacharatos S, Repantis T, Michael A, Karachalios D: Evolution of bone mineral density after percutaneous kyphoplasty in fresh osteoporotic vertebral body fractures and adjacent vertebrae along with sagittal spine alignment. J Spinal Disord Tech 2008, 21:293-298.
• [10]Boger A, Bisig A, Bohner M, Heini P, Schneider E: Variation of the mechanical properties of PMMA to suit osteoporotic cancellous bone. J Biomater Sci Polym Ed 2008, 19:1125-1142.
• [11]Yang SC, Chen WJ, Yu SW, Tu YK, Kao YH, Chung KC: Revision strategies for complications and failure of vertebroplasties. Eur Spine J 2006, 17:982-988.
• [12]Manson NA, Phillips FM: Minimally invasive techniques for the treatment of osteoporotic vertebral fractures. J Bone Joint Surg Am 2006, 88:1862-1872.
• [13]Chotigavanich C, Sanpakit S, Wantthanaapisith T, Thanapipatsiri S, Chotigavanich C: The surgical treatment of the osteoporotic vertebral compression fracture in the elderly patients with the spinal instrumentation. J Med Assoc Thai 2009, 92(Suppl 5):S109-S115.
• [14]Lee HH, Wu SS, Chuang SY, Yeh TT, Chen PQ: Biomechanical evaluation of transpedicularly placed intravertebral support for the management of osteoporotic vertebral compression fractures. J Musculoskeletal Research 2008, 11:37-43. [http://www.worldscientific.com/doi/abs/10.1142/S0218957708001936 webcite]
• [15]Voggenreiter G: Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures. Spine 2005, 30:2806-2812.
• [16]Gray LA, Jarvik JG, Heagerty PJ, Hollingworth W, Stout L, Comstock BA, Turner JA, Kallmes DF: Investigational Vertebroplasty Efficacy and Safety Trial (INVEST): a randomized controlled trial of percutaneous vertebroplasty. BMC Musculoskelet Disord 2007, 8:126. BioMed Central Full Text
• [17]Uppin AA, Hirsch JA, Centenera LV, Pfiefer BA, Pazianos AG, Choi IS: Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 2003, 226:119-124.
• [18]Baroud G, Vant C, Wilcox R: Long-term effects of vertebroplasty: adjacent vertebral fractures. J Long Term Eff Med Implants 2006, 16:265-280.
• [19]Uchida K, Kobayashi S, Nakajima H: Anterior expandable strut cage replacement for osteoporotic thoracolumbar vertebral collapse. J Neurosurg Spine 2006, 4:454-462.
• [20]McLain RF, Sparling E, Benson DR: Early failure of short-segment pedicle instrumentation for thoracolumbar fractures: a preliminary report. J Bone Joint Surg Am 1993, 75:162-167.
• [21]Maiman DJ, Pintar F, Yoganandan N, Reinartz J: Effects of anterior vertebral grafting on the traumatized lumbar spine after pedicle screw-plate fixation. Spine 1993, 18:2423-2430.
• [22]Liao JC, Fan KF, Chen WJ, Chen LH, Kao HK: Transpedicular bone grafting following short-segment posterior instrumentation for acute thoracolumbar burst fracture. Orthopedics 2009, 32:493.
• [23]Alanay A, Acaroglu E, Yazici M, Oznur A, Surat A: Short-segment pedicle instrumentation of thoracolumbar burst fractures: does transpedicular intracorporeal grafting prevent early failure? Spine 2001, 26:213-217.
• [24]Li KC, Li AF, Hsieh CH, Chen HH: Transpedicle body augmenter in painful osteoporotic compression fractures. Eur Spine J 2007, 16:589-598.
• [25]Hiwatashi A, Westesson PL, Yoshiura T, Noguchi T, Togao O, Yamashita K, Kamano H, Honda H: Kyphoplasty and vertebroplasty produce the same degree of height restoration. AJNR Am J Neuroradiol 2009, 30:669-673.
• [26]Röllinghoff M, Siewe J, Zarghooni K, Sobottke R, Alparslan Y, Eysel P, Delank KS: Effectiveness, security and height restoration on fresh compression fractures: a comparative prospective study of vertebroplasty and kyphoplasty. Minim Invasive Neurosurg 2009, 52:233-237.
• [27]Nardi A, Tarantino U, Ventura L, Armotti P, Resmini G, Cozzi L, Tonini G, Ramazzina E, Rossini M: Domino effect: mechanic factors role. Clin Cases Miner Bone Metab 2011, 8(2):38-42.
• [28]Kim YJ, Bridwell KH, Lenke LG, Glattes CR, Rhim S, Cheh G: Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up. Spine 2008, 33(20):2179-2184.
• [29]Yagi M, King AB, Boachie-Adjei O: Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Spine 2012, 37(17):1479-1489.