Osteoporotic Thoracolumbar Vertebral Fractures With Neurological Deficit Treated by Balloon Kyphoplasty Augmented with Newly Developed Minimally Invasive Posterior Hook Stabilization

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2021 Dec 24

PMID 34950559

Authors

Toshio Doi

Ryutaro Kozuma

Junichi Arima

Affiliations

Soon will be listed here.

Abstract

Most osteoporotic vertebral fractures (OVFs) are treated conservatively, but surgery is often indicated for residual pain, neuropathy, or severe deformity. OVFs tend to develop in elderly patients, so less invasive surgery is desirable. Surgery is mainly performed to stabilize the fractured vertebral body. Percutaneous cement augmentation, such as via balloon kyphoplasty (BKP), has produced satisfactory results as a surgical method for managing OVFs. Posterior fixation with implants is often performed with or without cement augmentation when stronger fixation is considered necessary for OVFs with local kyphosis and angular instability. Pedicle screws (PSs) are widely used as an implant for posterior fixation, but given the risk of backing out in bones with severe osteoporosis, several measures have been taken to increase the strength such as by adding hooks. In cases of osteoporosis, hooks that can use cortical bone as an anchor are considered more useful than PS but are rarely used in minimally invasive surgery. We developed a minimally invasive posterior hook stabilization approach to directly stabilize the posterior spinal components as a new augmentation method for BKP and applied it to four cases of thoracolumbar OVF with neurological symptoms. The operation time was about 60 minutes, including BKP, and the estimated blood loss was about 10 ml. No postoperative implant problems occurred, and in all cases, neurological symptoms, such as buttocks and leg pain, were alleviated at an early stage after surgery. One patient had a postoperative adjacent vertebral body fracture that was conservatively treatable. Minimally invasive posterior hook stabilization, which we developed as a way of augmenting BKP, was considered useful for managing vertebral body fractures of the thoracolumbar spine with local kyphosis and angular instability.

References

Ohba T, Ebata S, Clinton D, Koyama K, Haro H . Instability of treated vertebrae after balloon kyphoplasty causing paraparesis in osteoporotic vertebral compression fracture: a report of two cases. Eur Spine J. 2012; 22 Suppl 3:S341-5. PMC: 3641248. DOI: 10.1007/s00586-012-2414-9. View

Li Z, Wang Y, Xu Y, Xu W, Zhu X, Chen C . Efficacy analysis of percutaneous pedicle screw fixation combined with percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures with kyphosis. J Orthop Surg Res. 2020; 15(1):53. PMC: 7027033. DOI: 10.1186/s13018-020-1583-1. View

Uchida K, Nakajima H, Yayama T, Miyazaki T, Hirai T, Kobayashi S . Vertebroplasty-augmented short-segment posterior fixation of osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine: comparisons with posterior surgery without vertebroplasty and anterior surgery. J Neurosurg Spine. 2010; 13(5):612-21. DOI: 10.3171/2010.5.SPINE09813. View

Sun E, Alkalay R, Vader D, Snyder B . Preventing distal pullout of posterior spine instrumentation in thoracic hyperkyphosis: a biomechanical analysis. J Spinal Disord Tech. 2009; 22(4):270-7. DOI: 10.1097/BSD.0b013e31816a6887. View

Hosogane N, Nojiri K, Suzuki S, Funao H, Okada E, Isogai N . Surgical Treatment of Osteoporotic Vertebral Fracture with Neurological Deficit-A Nationwide Multicenter Study in Japan. Spine Surg Relat Res. 2019; 3(4):361-367. PMC: 6834469. DOI: 10.22603/ssrr.2019-0004. View

Spross C, Aghayev E, Kocher R, Roder C, Forster T, Kuelling F . Incidence and risk factors for early adjacent vertebral fractures after balloon kyphoplasty for osteoporotic fractures: analysis of the SWISSspine registry. Eur Spine J. 2013; 23(6):1332-8. DOI: 10.1007/s00586-013-3052-6. View

Behrbalk E, Uri O, Folman Y, Rickert M, Kaiser R, Boszczyk B . Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures. Global Spine J. 2016; 6(7):710-720. PMC: 5077718. DOI: 10.1055/s-0035-1569460. View

Tai C, Hsieh P, Chen W, Chen L, Chen W, Lai P . Biomechanical comparison of lumbar spine instability between laminectomy and bilateral laminotomy for spinal stenosis syndrome - an experimental study in porcine model. BMC Musculoskelet Disord. 2008; 9:84. PMC: 2438358. DOI: 10.1186/1471-2474-9-84. View

Wilke H, Kaiser D, Volkheimer D, Hackenbroch C, Puschel K, Rauschmann M . A pedicle screw system and a lamina hook system provide similar primary and long-term stability: a biomechanical in vitro study with quasi-static and dynamic loading conditions. Eur Spine J. 2016; 25(9):2919-28. DOI: 10.1007/s00586-016-4679-x. View

10.

Katsumi K, Hirano T, Watanabe K, Ohashi M, Yamazaki A, Ito T . Surgical treatment for osteoporotic thoracolumbar vertebral collapse using vertebroplasty with posterior spinal fusion: a prospective multicenter study. Int Orthop. 2016; 40(11):2309-2315. DOI: 10.1007/s00264-016-3222-3. View

11.

Roder C, Boszczyk B, Perler G, Aghayev E, Kulling F, Maestretti G . Cement volume is the most important modifiable predictor for pain relief in BKP: results from SWISSspine, a nationwide registry. Eur Spine J. 2013; 22(10):2241-8. PMC: 3804705. DOI: 10.1007/s00586-013-2869-3. View

12.

Hoshino M, Nakamura H, Terai H, Tsujio T, Nabeta M, Namikawa T . Factors affecting neurological deficits and intractable back pain in patients with insufficient bone union following osteoporotic vertebral fracture. Eur Spine J. 2009; 18(9):1279-86. PMC: 2899536. DOI: 10.1007/s00586-009-1041-6. View

13.

Tarukado K, Tono O, Ikuta K, Harimaya K, Matsumoto Y, Okada S . Instability of the Vertebrae Remains following Balloon Kyphoplasty. Global Spine J. 2014; 4(2):89-92. PMC: 4078138. DOI: 10.1055/s-0034-1370790. View

14.

Ikeda Y, Sudo A, Yamada T, Uchida A . Mortality after vertebral fractures in a Japanese population. J Orthop Surg (Hong Kong). 2010; 18(2):148-52. DOI: 10.1177/230949901001800204. View

15.

Goel V, Fromknecht S, Nishiyama K, Weinstein J, Liu Y . The role of lumbar spinal elements in flexion. Spine (Phila Pa 1976). 1985; 10(6):516-23. DOI: 10.1097/00007632-198507000-00005. View

16.

Tarukado K, Tono O, Harimaya K, Doi T . Does an osteoporotic vertebral fracture treated by balloon kyphoplasty successfully achieve bone union during the follow-up? A retrospective study with a minimum 2-year follow-up. J Orthop. 2017; 14(4):480-483. PMC: 5558646. DOI: 10.1016/j.jor.2017.08.005. View

17.

Taylor R, Taylor R, Fritzell P . Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine (Phila Pa 1976). 2006; 31(23):2747-55. DOI: 10.1097/01.brs.0000244639.71656.7d. View