Article
Postoperative changes in sagittal balance after therapy with new craniocaudal expandable implant for the minimally invasive reconstruction of osteoporotic vertebral body compression fractures – 4 years of experience with 120 patients
Postoperative Veränderungen der sagittalen Balance nach Behandlung mit kraniokaudal expandierbarem Implantat zur minimal-invasiven Rekonstruktion von osteoprotischen Kompressionsfrakturen – 4 Jahre Erfahrungen mit 120 Patienten
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Authors
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Jamal Assaf
- Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Klinik für Neurochirurgie, Neubrandenburg, Deutschland
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Michael J. Fritsch
- Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Klinik für Neurochirurgie, Neubrandenburg, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: We present the surgical technique and patient data of120 patients with4 years follow up treated for osteoporotic compression fractures of the thoracic and lumbar spine. Patient data were collected prospectively. The aim of this study is to evaluate the restoration of sagittal balance with this technique and the clinical outcome for the patients.
Methods: We treated 120 patients for133spinal osteoporotic fractures with an age ranging from 46-88 years. OF-Classification of osteoporotic vertebral body fracture (OF 0-5) was type OF 0 (23), OF 1 (30), OF 2 (24), OF 3 (22), OF 4 (31) and OF 5 (3). All implants were percutaneous transpedicular. For augmentation PMMA or a combination of PMMA/hydroxyapatite was used. All patients had a preop clinical examination, spine x-ray, CT and MRI as well as a postop clinical examination and x-ray after 1 month, 1 year and 3 years. For each patient we measured the height of the vertebral body as well as the kyphosis angle of the fractured vertebral body. Restoration of the spinal profiles was assessed with spine x-ray. All included patients had a 4-year follow up.
Results: Within the 4 years follow-up period, the reduction of pain according to VA-scale was 77%. Increase of vertebral body height was 15% after the procedure and 11% after 3 years. The kyphosis angle was -6° prior to surgery and -4,5° 3 year later. The restoration of the sagittal balance was detectable in 89% of the cases. Cement leak was seen in40,6%, in all of them without neurologic deficits except for one case. There was no reoperation in the same segment within 4 years. Sagittal vertical axis (SVA): Pre-op: 6,98 + 3,0 cm, Post-op: 5,01 + 2,98 cm.
Conclusion: The presented method with a craniocaudal expandable implant is efficient and is providing excellent results after 4 years follow up. We achieved long lasting reduction of pain and pain medication in our patients. This technique allows a restoration of sagittal balance in most cases.
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