Article
Changes in sagittal balance after minimally invasive operative reconstruction of osteoporotic vertebral body compression fractures with craniocaudal expandable implant: 5 years experience with 200 patients
Veränderungen der sagittalen Balancenach operativer minimalinvasiver Rekonstruktion von osteoporotischen Wirbelkörperkompressionsfrakturen mit einem kraniokaudalen expandierbaren Implantat: 5 Jahre Erfahrung mit 200 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
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Ranny Assaf
- Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Klinik für Neurochirurgie, Neubrandenburg, Deutschland
| Published: | May 25, 2022 |
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Outline
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Objective: We present the surgical technique and patient data of 200 patients with 5 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: In our clinic between October 2014 and October 2021, 436 patients with vertebral compression fractures received minimally invasive treatment with a new cranio-caudal expandable implant.
We treated 200 patients for 220 spinal osteoporotic fractures with an age ranging from 44-82 years. OF-Classification of osteoporotic vertebral body fracture (OF 0-5) was type OF 0 (32), OF 1 (49), OF 2 (42), OF 3 (39), OF 4 (50) and OF 5 (8). 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, 3 Year and 3 Year. 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 5-year follow-up.
Results: Within the 5 years follow-up period, the reduction of pain according to VA-scale was 62%. Increase of vertebral body height was 15% after the procedure and 10% after 5 years. The kyphosis angle was -6° prior to surgery and -4° 5 year later. The restoration of the sagittal balance was detectable in 89% of the cases. Sagittal vertical axis (SVA): Pre-op: 6,95±5,3 cm, Post-op: 5,08±3,43 cm. Cement leak was seen in 90 Patients (45%) and incorrect position of the implant in 3 Cases (1,5%), in all of them without neurologic deficit. The was no reoperation in the same segment within 5 years.
Conclusion: The presented method with a craniocaudal expandable implant is efficient, safe and is providing excellent results after 5 years follow up. We achieved long lasting reduction of pain and pain medication in our patients. This technique allows a restoration and improvement of sagittal balance in most cases.
