CLASSIFICATION AND TREATMENT STRATEGIES OF SYMP TOMATIC SEVERE OSTEOPOROTIC VERTEBRAL FRACTURE AND COLLAPSE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGShuncong ^1,2 , MOLing ¹ ,  LIANGDe ¹ , JIANGXiaobing ¹ , YANGZhidong ¹ , TANGYongchao ¹ , JINDaxiang ¹ , YAOZhensong ¹ , GUODanqing ¹ , FENGPengbo ²

1. Department of Spinal Surgery, the First Affiliated Hospital of Guangzhou Traditional Chinese Medicine University, Guangzhou Guangdong, 510405, P. R. China;
2. the First School of Clinical Medicine, Guangzhou Traditional Chinese Medicine University;

Corresponding?author：

LIANGDe, Email: spinedr2011@163.com

Keywords：

Osteoporosis; Vertebral fracture and collapse; Percutaneous vertebral augmentation; Fixation strengthened with bone cement; Osteotomy; Individualized strategy

DOI：

10.7507/1002-1892.20160039

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Objective To investigate the classification and treatment strategies of symptomatic severe osteoporotic vertebral fracture and collapse. Methods Between August 2010 and January 2014, 42 patients with symptomatic severe osteoporotic vertebral fracture and collapse were treated, and the clinical data were retrospectively analyzed. According to clinical symptom and imaging materials, 23 cases were classified as type I (local pain, limitation of motion, no neurological symptom, and no obvious deformity), 12 cases as type II (slight neurological symptom and kyphotic Cobb angle ≤ 30°), and 7 cases as type III (severe neurological symptom and kyphotic Cobb angle <30°). In 23 type I patients, 17 underwent percutaneous vertebral augmentation, 6 underwent posterior pedicle screw fixation strengthened with bone cement combined with percutaneous vertebral augmentation. In 12 type II patients, they were treated with local spinal decompression and internal fixation strengthened with bone cement. In 7 type III patients, 5 underwent posterior osteotomy, and 2 underwent one stage posterior approach of vertebral resection and reconstruction. The visual analogue scale (VAS), Oswestry disability index (ODI), and local kyphotic Cobb angle were used to evaluate the neurological function. The complications were recorded. Results The operation was successfully completed in all patients. Wound infection and ketoacidosis secondary to stress blood glucose rise occurred in 1 case of type III patients respectively, and were cured after corresponding treatment; primary healing of wound was obtained in the other patients. The patients were followed up from 6 to 36 months (mean, 11.6 months). The nerve function was improved in 17 cases, and micturition disability was observed in 2 cases. Asymptomatic cement leakage occurred in 13 cases (30.95%) (7 cases in type I, 4 cases in type II, and 2 cases in type III). No bone cement dislocation and internal fixation failure were found during follow-up. The VAS score, ODI, and the local kyphotic Cobb angle at 1 week and last follow-up were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found between at 1 week and last follow-up (P>0.05). Conclusion In order to improve the effectiveness and reduce the risk and complications of operation, individualized strategies should be performed according to different types of severe osteoporotic vertebral fracture and collapse.

Citation： ZHANGShuncong, MOLing, LIANGDe, JIANGXiaobing, YANGZhidong, TANGYongchao, JINDaxiang, YAOZhensong, GUODanqing, FENGPengbo. CLASSIFICATION AND TREATMENT STRATEGIES OF SYMP TOMATIC SEVERE OSTEOPOROTIC VERTEBRAL FRACTURE AND COLLAPSE. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(2): 189-196. doi: 10.7507/1002-1892.20160039 Copy

1.	?Nieuwenhuijse MJ, van Erkel AR, Dijkstra PD. Percutaneous vertebroplasty in very severe osteoporotic vertebral compression fractures:feasible and beneficial. J Vasc Interv Radiol, 2011, 22(7):1017-1023.
2.	Miyagi R, Sakai T, Bhatia NN, et al. Anterior thoracolumbar reconstruction surgery for late collapse following vertebroplasty:report of three cases. J Med Invest, 2011, 58(1-2):148-153.
3.	Chang MC, Kao HC, Ying SH, et al. Polymethylmethacrylate augmentation of cannulated pedicle screws for fixation in osteoporotic spines and comparison of its clinical results and biomechanical characteristics with the needle injection method. J Spinal Disord Tech, 2013, 26(6):305-315.
4.	李超, 于海洋, 付青松, 等. 后柱切除后伸壓縮中柱矯治胸腰段骨質疏松性重度椎體壓縮骨折伴后凸畸形. 中國脊柱脊髓雜志, 2013, 23(8):700-705.
5.	Cooper C, Atkinson EJ, O'Fallon WM, et al. Incidence of clinically diagnosed vertebral fractures. A population based study in Rochester, Minnesota, 1985-1989. J Bone and Miner Res, 1992, 7(2):221-227.
6.	Ohba T, Ebata S, Clinton D, et al. Instability of treated vertebrae after balloon kyphoplasty causing paraparesis in osteoporotic vertebral compression fracture:a report of two cases. Eur Spine J, 2013, 22 Suppl 3:S341-345.
7.	張順聰, 江曉兵, 梁德, 等. Ⅲ期Kümmell's病的過伸位CT分型及其意義. 中國脊柱脊髓雜志, 2012, 22(5):387-392.
8.	Pham T, Azulay-Parrado J, Champsaur P, et al. "Occult" osteoporotic vertebral fractures:vertebral body fractures without radiologic collapse. Spine (Phila Pa 1976), 2005, 30(21):2430-2435.
9.	朱佳俊, 屠冠軍. 椎體后凸成形術與椎體成形術治療骨質疏松性椎體壓縮骨折的Meta分析. 中國脊柱脊髓雜志, 2011, 21(10):848-852.
10.	Deramond H, Derpriester C, Galibert P, et al. Percutaneous vertebroplasty with polymethylmethacrylate:technique, indications, and results. Radiol Clin North Am, 1998, 36(3):533-546.
11.	唐海, 陳浩, 王炳強, 等. 椎體后凸成形術治療重度骨質疏松性椎體壓縮骨折. 中華骨科雜志, 2010, 30(10):978-983.
12.	Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14):1503-1507.
13.	Arun R, Dabke HV. Comparison of three types of lumbar osteotomy for ankylosing spondylitis:a case series and evolution of a safe technique for instrumented reduction. Eur Spine J, 2011, 20(12):2252-2260.
14.	Hehne HJ, Z leike K, B?hm H. Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis report on 177 cases. Clin Orthop Relat Res, 1990, (258):49-55.
15.	Li F, Sagi HC, Liu B, et al. Comparative evaluation of single-level closing-wedge vertebral osteotomies for the correction of fixed kyphotic deformity of the lumbar spine:a eadaverie study. Spine (Phila Pa 1976), 2001, 26(21):2385-2391.
16.	Uchida K, Kobayashi S, Matsuzaki M, et al. Anterior versus posterior surgery for osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine. Eur spine J, 2006, 15(15):1759-1767.
17.	Kanayama M, Ishida T, Hashimoto T, et al. Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebral collapse. J Spinal Disord Tech, 2010, 23(1):53-56.
18.	Sudo H, Ito M, Abumi K, et al. One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neu-rological deficits. Eur Spine J, 2010, 19(6):907-915.

1. ?Nieuwenhuijse MJ, van Erkel AR, Dijkstra PD. Percutaneous vertebroplasty in very severe osteoporotic vertebral compression fractures:feasible and beneficial. J Vasc Interv Radiol, 2011, 22(7):1017-1023.
2. Miyagi R, Sakai T, Bhatia NN, et al. Anterior thoracolumbar reconstruction surgery for late collapse following vertebroplasty:report of three cases. J Med Invest, 2011, 58(1-2):148-153.
3. Chang MC, Kao HC, Ying SH, et al. Polymethylmethacrylate augmentation of cannulated pedicle screws for fixation in osteoporotic spines and comparison of its clinical results and biomechanical characteristics with the needle injection method. J Spinal Disord Tech, 2013, 26(6):305-315.
4. 李超, 于海洋, 付青松, 等. 后柱切除后伸壓縮中柱矯治胸腰段骨質疏松性重度椎體壓縮骨折伴后凸畸形. 中國脊柱脊髓雜志, 2013, 23(8):700-705.
5. Cooper C, Atkinson EJ, O'Fallon WM, et al. Incidence of clinically diagnosed vertebral fractures. A population based study in Rochester, Minnesota, 1985-1989. J Bone and Miner Res, 1992, 7(2):221-227.
6. Ohba T, Ebata S, Clinton D, et al. Instability of treated vertebrae after balloon kyphoplasty causing paraparesis in osteoporotic vertebral compression fracture:a report of two cases. Eur Spine J, 2013, 22 Suppl 3:S341-345.
7. 張順聰, 江曉兵, 梁德, 等. Ⅲ期Kümmell's病的過伸位CT分型及其意義. 中國脊柱脊髓雜志, 2012, 22(5):387-392.
8. Pham T, Azulay-Parrado J, Champsaur P, et al. "Occult" osteoporotic vertebral fractures:vertebral body fractures without radiologic collapse. Spine (Phila Pa 1976), 2005, 30(21):2430-2435.
9. 朱佳俊, 屠冠軍. 椎體后凸成形術與椎體成形術治療骨質疏松性椎體壓縮骨折的Meta分析. 中國脊柱脊髓雜志, 2011, 21(10):848-852.
10. Deramond H, Derpriester C, Galibert P, et al. Percutaneous vertebroplasty with polymethylmethacrylate:technique, indications, and results. Radiol Clin North Am, 1998, 36(3):533-546.
11. 唐海, 陳浩, 王炳強, 等. 椎體后凸成形術治療重度骨質疏松性椎體壓縮骨折. 中華骨科雜志, 2010, 30(10):978-983.
12. Mahar A, Kim C, Wedemeyer M, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976), 2007, 32(14):1503-1507.
13. Arun R, Dabke HV. Comparison of three types of lumbar osteotomy for ankylosing spondylitis:a case series and evolution of a safe technique for instrumented reduction. Eur Spine J, 2011, 20(12):2252-2260.
14. Hehne HJ, Z leike K, B?hm H. Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis report on 177 cases. Clin Orthop Relat Res, 1990, (258):49-55.
15. Li F, Sagi HC, Liu B, et al. Comparative evaluation of single-level closing-wedge vertebral osteotomies for the correction of fixed kyphotic deformity of the lumbar spine:a eadaverie study. Spine (Phila Pa 1976), 2001, 26(21):2385-2391.
16. Uchida K, Kobayashi S, Matsuzaki M, et al. Anterior versus posterior surgery for osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine. Eur spine J, 2006, 15(15):1759-1767.
17. Kanayama M, Ishida T, Hashimoto T, et al. Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebral collapse. J Spinal Disord Tech, 2010, 23(1):53-56.
18. Sudo H, Ito M, Abumi K, et al. One-stage posterior instrumentation surgery for the treatment of osteoporotic vertebral collapse with neu-rological deficits. Eur Spine J, 2010, 19(6):907-915.

Chinese Journal of Reparative and Reconstructive Surgery

CLASSIFICATION AND TREATMENT STRATEGIES OF SYMP TOMATIC SEVERE OSTEOPOROTIC VERTEBRAL FRACTURE AND COLLAPSE

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