Maximilian Schwendner1,2, Stefan Motov3, Yu-Mi Ryang4, Bernhard Meyer1, Sandro M Krieg5,6. 1. Department of Neurosurgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. 2. TUM Neuroimaging Center, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany. 3. Department of Neurosurgery, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany. 4. Department of Neurosurgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany. 5. Department of Neurosurgery, Klinikum Rechts Der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany. Sandro.Krieg@tum.de. 6. TUM Neuroimaging Center, School of Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany. Sandro.Krieg@tum.de.
Abstract
PURPOSE: In the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was to evaluate clinical and radiological outcomes after dorsal or 360° instrumentation of osteoporotic fractures of the thoracolumbar spine in a cohort of patients representing clinical reality. METHODS: A total of 116 consecutive patients were operated on between 2008 and 2020. Inclusion criteria were osteoporotic fracture, thoracolumbar location, and dorsal instrumentation. In 79 cases, vertebral body replacement (VBR) was performed additionally. Patient outcomes including complications, EQ-5D at follow-up, and sagittal correction were analyzed. RESULTS: Medical and surgical complications occurred in 59.5% of patients with 360° instrumentation compared to 64.9% of patients with dorsal instrumentation only (p = 0.684). Dorsal instrumentation plus VBR resulted in a sagittal correction of 9.3 ± 7.4° (0.1-31.6°) compared to 6.0 ± 5.6° (0.2-22.8°) after dorsal instrumentation only, respectively (p = 0.0065). EQ-5D was completed by 79 patients after 4.00 ± 2.88 years (0.1-11.8 years) and was 0.56 ± 0.32 (- 0.21-1.00) for VBR compared to 0.56 ± 0.34 (- 0.08-1.00) without VBR after dorsal instrumentation (p = 0.994). CONCLUSION: 360° instrumentation represents a legitimate surgical technique with no additional morbidity even for the elderly and multimorbid osteoporotic population. Particularly, if sufficient long-term construct stability is in doubt or ventral stenosis is present, there is no need to abstain from additional ventral reinforcement and decompression.
PURPOSE: In the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was to evaluate clinical and radiological outcomes after dorsal or 360° instrumentation of osteoporotic fractures of the thoracolumbar spine in a cohort of patients representing clinical reality. METHODS: A total of 116 consecutive patients were operated on between 2008 and 2020. Inclusion criteria were osteoporotic fracture, thoracolumbar location, and dorsal instrumentation. In 79 cases, vertebral body replacement (VBR) was performed additionally. Patient outcomes including complications, EQ-5D at follow-up, and sagittal correction were analyzed. RESULTS: Medical and surgical complications occurred in 59.5% of patients with 360° instrumentation compared to 64.9% of patients with dorsal instrumentation only (p = 0.684). Dorsal instrumentation plus VBR resulted in a sagittal correction of 9.3 ± 7.4° (0.1-31.6°) compared to 6.0 ± 5.6° (0.2-22.8°) after dorsal instrumentation only, respectively (p = 0.0065). EQ-5D was completed by 79 patients after 4.00 ± 2.88 years (0.1-11.8 years) and was 0.56 ± 0.32 (- 0.21-1.00) for VBR compared to 0.56 ± 0.34 (- 0.08-1.00) without VBR after dorsal instrumentation (p = 0.994). CONCLUSION: 360° instrumentation represents a legitimate surgical technique with no additional morbidity even for the elderly and multimorbid osteoporotic population. Particularly, if sufficient long-term construct stability is in doubt or ventral stenosis is present, there is no need to abstain from additional ventral reinforcement and decompression.
Authors: Shanmuganathan Rajasekaran; Rishi M Kanna; Klaus J Schnake; Alexander R Vaccaro; Gregory D Schroeder; Said Sadiqi; Cumhur Oner Journal: J Orthop Trauma Date: 2017-09 Impact factor: 2.512
Authors: B Ettinger; D M Black; M C Nevitt; A C Rundle; J A Cauley; S R Cummings; H K Genant Journal: J Bone Miner Res Date: 1992-04 Impact factor: 6.741
Authors: E Hernlund; A Svedbom; M Ivergård; J Compston; C Cooper; J Stenmark; E V McCloskey; B Jönsson; J A Kanis Journal: Arch Osteoporos Date: 2013-10-11 Impact factor: 2.617
Authors: Klaus John Schnake; Thomas R Blattert; Patrick Hahn; Alexander Franck; Frank Hartmann; Bernhard Ullrich; Akhil Verheyden; Sven Mörk; Volker Zimmermann; Oliver Gonschorek; Michael Müller; Sebastian Katscher; Andre El Saman; Gholam Pajenda; Robert Morrison; Christian Schinkel; Stefan Piltz; Axel Partenheimer; Christian W Müller; Erol Gercek; Michael Scherer; Nabila Bouzraki; Frank Kandziora Journal: Global Spine J Date: 2018-09-07