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Hybrid stabilization of unstable osteoporotic thoracolumbar vertebral body fractures: clinical and radiological outcome after a mean of 4 years

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Abstract

Purpose

The aim of this study was to evaluate midterm results after hybrid stabilization of unstable osteoporotic fractures of the thoracolumbar junction.

Methods

This retrospective study was performed at a level I trauma center. A total of 113 patients aged 61 and older were stabilized using hybrid stabilization consisting of short-segmental posterior instrumentation and augmentation of the fractured vertebral body after suffering an unstable osteoporotic vertebral body fracture at the thoracolumbar spine. All patients were treated by hybrid stabilization. The primary outcome parameters were the ODI score and loss of reduction. Secondary radiological outcome parameters were the sagittal alignment parameters.

Results

Seventy-two women and 41 men (74.6 ± 6.8 years) were included. Sixty-nine patients (61%) were re-evaluated after a mean of 48 months. Seventeen patients have died during the follow-up period (15%). A total of five in-patient complications were documented (4.4%). Additionally, 12 patients (17.4%) suffered from further osteoporotic vertebral body fractures affecting vertebral bodies of different levels. The average ODI score at the final follow-up was 29.9 (± 22.0). Thereby, 66.6% of all patients had low to moderate limitations. The average regional sagittal loss of reduction was 7.4% (± 5.6%). Loss of reduction was below 10° in 78% of the patients. There were statistically significant correlations between the loss of reduction and the ODI score, pelvic incidence and latest Cobb angle, and between the ODI scores and the lumbar lordosis.

Conclusions

The majority of patients had low or moderate limitations and low to moderate reduction loss. Thereby, high loss of reduction correlated directly with inferior outcomes.

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References

  1. Abdelgawaad AS, Ezzati A, Govindasamy R, Krajnovic B, Elnady B, Said GZ (2017) Kyphoplasty for osteoporotic vertebral fractures with posterior wall injury. Spine J. https://doi.org/10.1016/j.spinee.2017.11.001

    Article  PubMed  Google Scholar 

  2. Aubry-Rozier B, Stoll D, Gonzalez Rodriguez E, Hans D, Prudent V, Seuret A, Farron A, Lamy O (2018) Impact of a fracture liaison service on patient management after an osteoporotic fracture: the CHUV FLS. Swiss Med Wkly 148:w14579. https://doi.org/10.4414/smw.2018.14579

    Article  PubMed  Google Scholar 

  3. Bae H, Shen M, Maurer P, Peppelman W, Beutler W, Linovitz R, Westerlund E, Peppers T, Lieberman I, Kim C, Girardi F (2010) Clinical experience using Cortoss for treating vertebral compression fractures with vertebroplasty and kyphoplasty: twenty four-month follow-up. Spine (Phila Pa 1976) 35(20):E1030–E1036. https://doi.org/10.1097/BRS.0b013e3181dcda75

    Article  Google Scholar 

  4. Buchbinder R, Johnston RV, Rischin KJ, Homik J, Jones CA, Golmohammadi K, Kallmes DF (2018) Percutaneous vertebroplasty for osteoporotic vertebral compression fracture. Cochrane Database Syst Rev 4:CD006349. https://doi.org/10.1002/14651858.CD006349.pub3

    Article  PubMed  Google Scholar 

  5. Che H, Breuil V, Cortet B, Paccou J, Thomas T, Chapuis L, Debiais F, Mehsen-Cetre N, Javier RM, Loiseau Peres S, Roux C, Briot K (2018) Vertebral fractures cascade: potential causes and risk factors. Osteoporos Int. https://doi.org/10.1007/s00198-018-4793-1

    Article  PubMed  Google Scholar 

  6. Eschler A, Ender SA, Schiml K, Mittlmeier T, Gradl G (2015) Bony healing of unstable thoracolumbar burst fractures in the elderly using percutaneously applied titanium mesh cages and a transpedicular fixation system with expandable screws. PLoS ONE 10(2):e0117122. https://doi.org/10.1371/journal.pone.0117122

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Fuentes S, Blondel B, Metellus P, Gaudart J, Adetchessi T, Dufour H (2010) Percutaneous kyphoplasty and pedicle screw fixation for the management of thoraco-lumbar burst fractures. Eur Spine J 19(8):1281–1287. https://doi.org/10.1007/s00586-010-1444-4

    Article  PubMed  PubMed Central  Google Scholar 

  8. Josten C, Schmidt C, Spiegl U (2012) Osteoporotic vertebral body fractures of the thoracolumbar spine: diagnostics and therapeutic strategies. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen 83(10):866–874. https://doi.org/10.1007/s00104-012-2338-2

    Article  CAS  PubMed  Google Scholar 

  9. Kim HJ, Park S, Park SH, Park J, Chang BS, Lee CK, Yeom JS (2018) Prevalence of frailty in patients with osteoporotic vertebral compression fracture and its association with numbers of fractures. Yonsei Med J 59(2):317–324. https://doi.org/10.3349/ymj.2018.59.2.317

    Article  PubMed  Google Scholar 

  10. Kobayashi K, Ando K, Nishida Y, Ishiguro N, Imagama S (2018) Epidemiological trends in spine surgery over 10 years in a multicenter database. Eur Spine J 27(8):1698–1703. https://doi.org/10.1007/s00586-018-5513-4

    Article  PubMed  Google Scholar 

  11. Korovessis P, Mpountogianni E, Syrimpeis V (2016) Percutaneous pedicle screw fixation plus kyphoplasty for thoracolumbar fractures A2, A3 and B2. Eur Spine J. https://doi.org/10.1007/s00586-016-4743-6

    Article  PubMed  Google Scholar 

  12. Li Q, Sun J, Cui X, Jiang Z, Li T (2017) Analysis of correlation between degeneration of lower lumbar paraspinal muscles and spinopelvic alignment in patients with osteoporotic vertebral compression fracture. J Back Musculoskelet Rehabil 30(6):1209–1214. https://doi.org/10.3233/BMR-150506

    Article  PubMed  Google Scholar 

  13. Li X, Lu Y, Lin X (2017) Refracture of osteoporotic vertebral body after treatment by balloon kyphoplasty: three cases report. Medicine 96(49):e8961. https://doi.org/10.1097/MD.0000000000008961

    Article  PubMed  PubMed Central  Google Scholar 

  14. Li YX, Guo DQ, Zhang SC, Liang Yuan K, Mo GY, Li DX, Guo HZ, Tang Y, Luo PJ (2018) Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Int Orthop. https://doi.org/10.1007/s00264-018-3838-6

    Article  PubMed  PubMed Central  Google Scholar 

  15. Newman M, Minns Lowe C, Barker K (2016) Spinal orthoses for vertebral osteoporosis and osteoporotic vertebral fracture: a systematic review. Arch Phys Med Rehabil 97(6):1013–1025. https://doi.org/10.1016/j.apmr.2015.10.108

    Article  PubMed  Google Scholar 

  16. Rahamimov N, Mulla H, Shani A, Freiman S (2012) Percutaneous augmented instrumentation of unstable thoracolumbar burst fractures. Eur Spine J 21(5):850–854. https://doi.org/10.1007/s00586-011-2106-x

    Article  PubMed  Google Scholar 

  17. Riesner HJ, Kiupel K, Lang P, Stuby F, Friemert B, Palm HG (2016) Clinical relevance of cement leakage after radiofrequency Kyphoplasty vs. balloon Kyphoplasty: a prospective randomised study. Zeitschrift fur Orthopadie und Unfallchirurgie 154(4):370–376. https://doi.org/10.1055/s-0042-104069

    Article  PubMed  Google Scholar 

  18. Schnake KJ, Blattert TR, Hahn P, Franck A, Hartmann F, Ullrich B, Verheyden A, Mörk S, Zimmermann V, Gonschorek O, Müller M, Katscher S, Saman AE, Pajenda G, Morrison R, Schinkel C, Piltz S, Partenheimer A, Müller CW, Gercek E, Scherer M, Bouzraki N, Kandziora F, Spine Section of the German Society for Orthopaedics and Trauma (2018) Classification of osteoporotic thoracolumbar spine fractures: recommendations of the spine section of the German society for orthopaedics and trauma (DGOU). Global Spine J 8(2 Suppl):46S–49S. https://doi.org/10.1177/2192568217717972

    Article  PubMed  PubMed Central  Google Scholar 

  19. Spiegl U, Jarvers JS, Heyde CE, Josten C (2017) Osteoporotic vertebral body fractures of the thoracolumbar spine: indications and techniques of a 360 degrees -stabilization. Eur J Trauma Emerg Surg 43(1):27–33. https://doi.org/10.1007/s00068-016-0751-9

    Article  PubMed  Google Scholar 

  20. Spiegl UJ, Hauck S, Merkel P, Buhren V, Gonschorek O (2012) Long-term results of kyphoplasty with additive dorsal instrumentation of incomplete burst fractures of the thoracolumbar spine in the elderly. Zeitschrift fur Orthopadie und Unfallchirurgie 150(6):579–582. https://doi.org/10.1055/s-0032-1327936

    Article  CAS  PubMed  Google Scholar 

  21. Sun ZY, Li XF, Zhao H, Lin J, Qian ZL, Zhang ZM, Yang HL (2017) Percutaneous balloon Kyphoplasty in treatment of painful osteoporotic occult vertebral fracture: a retrospective study of 89 cases. Med Sci Monit Res 23:1682–1690

    Article  Google Scholar 

  22. Svedbom A, Borgstom F, Hernlund E, Strom O, Alekna V, Bianchi ML, Clark P, Curiel MD, Dimai HP, Jurisson M, Kallikorm R, Lember M, Lesnyak O, McCloskey E, Sanders KM, Silverman S, Solodovnikov A, Tamulaitiene M, Thomas T, Toroptsova N, Uuskula A, Tosteson ANA, Jonsson B, Kanis JA (2018) Quality of life for up to 18 months after low-energy hip, vertebral, and distal forearm fractures-results from the ICUROS. Osteoporos Int 29(3):557–566. https://doi.org/10.1007/s00198-017-4317-4

    Article  CAS  PubMed  Google Scholar 

  23. Uchida K, Nakajima H, Yayama T, Miyazaki T, Hirai T, Kobayashi S, Chen K, Guerrero AR, Baba H (2010) 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 13(5):612–621. https://doi.org/10.3171/2010.5.SPINE09813

    Article  PubMed  Google Scholar 

  24. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, Reinhold M, Aarabi B, Kandziora F, Chapman J, Shanmuganathan R, Fehlings M, Vialle L, Injury AOSC, Trauma Knowledge F (2013) AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 38(23):2028–2037. https://doi.org/10.1097/BRS.0b013e3182a8a381

    Article  Google Scholar 

  25. Verlaan JJ, Somers I, Dhert WJ, Oner FC (2015) Clinical and radiological results 6 years after treatment of traumatic thoracolumbar burst fractures with pedicle screw instrumentation and balloon assisted endplate reduction. Spine J 15(6):1172–1178. https://doi.org/10.1016/j.spinee.2013.11.044

    Article  PubMed  Google Scholar 

  26. Yasuda T, Kawaguchi Y, Suzuki K, Nakano M, Seki S, Watabnabe K, Kanamori M, Kimura T (2017) Five-year follow up results of posterior decompression and fixation surgery for delayed neural disorder associated with osteoporotic vertebral fracture. Medicine 96(51):e9395. https://doi.org/10.1097/MD.0000000000009395

    Article  PubMed  PubMed Central  Google Scholar 

  27. Zhao WT, Qin DP, Zhang XG, Wang ZP, Tong Z (2018) Biomechanical effects of different vertebral heights after augmentation of osteoporotic vertebral compression fracture: a three-dimensional finite element analysis. J Orthop Surg Res 13(1):32. https://doi.org/10.1186/s13018-018-0733-1

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics, Trauma Surgery and Reconstructive Surgery, University of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany

    Ulrich J. Spiegl, Christine Anemüller, Jan-Sven Jarvers, Nicolaus von der Höh, Christoph Josten & Christoph-Eckhard Heyde

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  1. Ulrich J. Spiegl
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  2. Christine Anemüller
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  3. Jan-Sven Jarvers
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  4. Nicolaus von der Höh
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  5. Christoph Josten
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  6. Christoph-Eckhard Heyde
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Correspondence to Ulrich J. Spiegl.

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Conflict of interest

This work was not supported by any external sources of funding. Two of the authors are in advisory boards of companies, C-EH for Fa Medacta, CJ for Fa Zimmer, Fa. Ziehm and Fa. Silony. Additionally J-SJ received horonary for speaking from Fa. Ziehm. Two aurthors (UJS and C-EH) received material supply for biomechanical testing by Fa. Medacta.

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Spiegl, U.J., Anemüller, C., Jarvers, JS. et al. Hybrid stabilization of unstable osteoporotic thoracolumbar vertebral body fractures: clinical and radiological outcome after a mean of 4 years. Eur Spine J 28, 1130–1137 (2019). https://doi.org/10.1007/s00586-019-05957-8

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