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J Orthop Sci. 2019 Aug 21. pii: S0949-2658(19)30251-9. doi: 10.1016/j.jos.2019.07.018. [Epub ahead of print]

Surgical outcomes of spinal fusion for osteoporotic vertebral fracture in the thoracolumbar spine: Comprehensive evaluations of 5 typical surgical fusion techniques.

Author information

1
Department of Orthopaedic Surgery, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata City, 951-8510, Japan. Electronic address: keiwatanabe_39jp@live.jp.
2
Department of Orthopaedic Surgery, Niigata University, 1-757 Asahimachidori, Chuo-ku, Niigata City, 951-8510, Japan.
3
Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
4
Department of Orthopaedic Surgery, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan.
5
Department of Orthopaedic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
6
Department of Orthopaedic Surgery, Nagasaki University, 1-7-1 Sakamoto, Nagasaki City, 852-8501, Japan.
7
Department of Orthopaedic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
8
Department of Orthopaedic Surgery, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka City, 812-8582, Japan.
9
Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke City, Tochigi, 329-0498, Japan.
10
Department of Orthopaedic Surgery, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara City, Kanagawa, 252-0374, Japan.
11
Department of Orthopaedic Surgery, Osaka Medical College, 2-7 Daigakumachi, Takatsuki City, Osaka, 569-0801, Japan.
12
Department of Orthopaedic Surgery, Tokai University, 143 Shimokasuya, Isehara City, Kanagawa 259-1193, Japan.
13
Department of Orthopaedic Surgery, Shinshu University, 3-1-1, Asahi, Matsumoto City, Nagano, 390-8621, Japan.
14
Department of Orthopaedic Surgery, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba City 260-8670, Japan.
15
Department of Orthopaedic Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya City, Aichi, 466-8560, Japan.
16
Department of Orthopaedic Surgery, Kochi University, Oko-cho Kohasu, Nankoku City, Kochi, 783-8505, Japan.
17
Department of Orthopaedic Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa City, Ishikawa, 920-0934, Japan.
18
Department of Orthopaedic Surgery, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan.
19
Department of Orthopaedic Surgery, Akita University, 1-1-1 Hondo, Akita City, 010-8543, Japan.
20
Department of Orthopaedic Surgery, Kobe University, 7-5-1 Kusunoki-cho, Chuou-ku, Kobe City, Hyogo, 650-0017, Japan.
21
Department of Orthopaedic Surgery, Eastern Chiba Medical Center, 3-6-2 Okayamadai, Togane, 283-8686, Japan.
22
Department of Orthopaedic Surgery, Nihon University Itabashi Hospital, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
23
Department of Orthopaedic Surgery, Hokkaido University, North-15, West-7, Kita-ku, Sapporo City, 060-8638, Japan.
24
Department of Orthopaedic Surgery, Iwate Medical University, 19-1 Uchimaru, Morioka City, Iwate, 020-8505, Japan.
25
Department of Orthopaedic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba City, Ibaraki, 305-8577, Japan.
26
Department of Orthopaedic Surgery, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima City, 734-8551, Japan.
27
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
28
Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan; Department of Orthopaedic Surgery, International University of Health and Welfare, Mita, Minato-ku, Tokyo, 108-8329, Japan.
29
Department of Orthopaedic Surgery, Kyorin University, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan; Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.

Abstract

BACKGROUND:

A consensus on the optimal surgical procedure for thoracolumbar OVF has yet to be reached due to the previous relatively small number of case series. The study was conducted to investigate surgical outcomes for osteoporotic vertebral fracture (OVF) in the thoracolumbar spine.

METHODS:

In total, 315 OVF patients (mean age, 74 years; 68 men and 247 women) with neurological symptoms who underwent spinal fusion with a minimum 2-year follow-up were included. The patients were divided into 5 groups by procedure: anterior spinal fusion alone (ASF group, n = 19), anterior/posterior combined fusion (APSF group, n = 27), posterior spinal fusion alone (PSF group, n = 40), PSF with 3-column osteotomy (3CO group, n = 92), and PSF with vertebroplasty (VP + PSF group, n = 137).

RESULTS:

Mean operation time was longer in the APSF group (p < 0.05), and intraoperative blood loss was lower in the VP + PSF group (p < 0.05). The amount of local kyphosis correction was greater in the APSF and 3CO groups (p < 0.05). Clinical outcomes were approximately equivalent among all groups.

CONCLUSION:

All 5 procedures resulted in acceptable neurological outcomes and functional improvement in walking ability. Moreover, they were similar with regard to complication rates, prevalence of mechanical failure related to the instrumentation, and subsequent vertebral fracture. Individual surgical techniques can be adapted to suit patient condition or severity of OVF.

PMID:
31445858
DOI:
10.1016/j.jos.2019.07.018

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