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：

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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.	楊德順, 雷丙俊, 廖亮, 等. 改良推管在單側椎弓根穿刺經皮椎體后凸成形術的應用. 中國修復重建外科雜志, 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, 劉少喻, 尹宗生. 多節段腰椎后路椎體間及后外側融合椎弓根螺釘內固定治療老年骨質疏松骨折合并胸腰椎后凸畸形. 中國組織工程研究, 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.	張旭, 于海洋, 梁成民, 等. 俯臥位脊柱全長加壓CT檢查在骨質疏松性脊柱骨折伴后凸畸形治療中的作用. 中國脊柱脊髓雜志, 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.	劉辰君, 朱震奇, 段碩, 等. 退變性胸腰交界區后凸及其矢狀位平衡代償機制的影像學分析. 中國脊柱脊髓雜志, 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.	金志輝, 方洪松, 陳森, 等. Ⅳ級截骨術在椎間盤組織嵌入椎體陳舊性胸腰椎骨折并后凸畸形手術治療中的應用. 中國骨與關節損傷雜志, 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.	齊強, 陳仲強, 郭昭慶, 等. 脊柱前方墊高-后方閉合截骨矯形術治療胸腰段脊柱后凸畸形的初步報告. 中華外科雜志, 2006, 44(8): 551-555.
20.	張國華, 杜旻育, 陳鴻昌, 等. 頂椎前凸截骨術治療胸椎或胸腰段骨質疏松性駝背畸形. 中國脊柱脊髓雜志, 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.	張銀昌, 趙清華, 秦曉東, 等. SRS-Schwab Ⅳ 級截骨聯合衛星棒技術治療胸腰椎陳舊性骨質疏松性骨折伴嚴重后凸畸形. 中國修復重建外科雜志, 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. 楊德順, 雷丙俊, 廖亮, 等. 改良推管在單側椎弓根穿刺經皮椎體后凸成形術的應用. 中國修復重建外科雜志, 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, 劉少喻, 尹宗生. 多節段腰椎后路椎體間及后外側融合椎弓根螺釘內固定治療老年骨質疏松骨折合并胸腰椎后凸畸形. 中國組織工程研究, 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. 張旭, 于海洋, 梁成民, 等. 俯臥位脊柱全長加壓CT檢查在骨質疏松性脊柱骨折伴后凸畸形治療中的作用. 中國脊柱脊髓雜志, 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. 劉辰君, 朱震奇, 段碩, 等. 退變性胸腰交界區后凸及其矢狀位平衡代償機制的影像學分析. 中國脊柱脊髓雜志, 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. 金志輝, 方洪松, 陳森, 等. Ⅳ級截骨術在椎間盤組織嵌入椎體陳舊性胸腰椎骨折并后凸畸形手術治療中的應用. 中國骨與關節損傷雜志, 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. 齊強, 陳仲強, 郭昭慶, 等. 脊柱前方墊高-后方閉合截骨矯形術治療胸腰段脊柱后凸畸形的初步報告. 中華外科雜志, 2006, 44(8): 551-555.
20. 張國華, 杜旻育, 陳鴻昌, 等. 頂椎前凸截骨術治療胸椎或胸腰段骨質疏松性駝背畸形. 中國脊柱脊髓雜志, 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. 張銀昌, 趙清華, 秦曉東, 等. SRS-Schwab Ⅳ 級截骨聯合衛星棒技術治療胸腰椎陳舊性骨質疏松性骨折伴嚴重后凸畸形. 中國修復重建外科雜志, 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

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