Abstract
The aim of the current study was to compare outcomes between lateral access vertebral reconstruction (LAVR) using a rectangular footplate cage and the conventional procedure using a cylindrical footplate cage in patients with osteoporotic vertebral fracture (OVF). We included 46 patients who underwent anterior–posterior combined surgery for OVF: 24 patients underwent LAVR (Group L) and 22 underwent the conventional procedure (Group C). Preoperative, postoperative, and 1- and 2-year follow-up X-ray images were used to measure local lordotic angle, correction loss, and cage subsidence (>2 mm in vertebral endplate depression). In anterior surgery, the operation time was significantly shorter (183 vs. 248 min, p < 0.001) and the blood loss was significantly less (148 vs. 406 mL, p = 0.01) in Group L than in Group C. In Group C, two patients had anterior instrumentation failure. Correction loss was significantly smaller in Group L than in Group C (1.9° vs. 4.9° at 1 year, p = 0.02; 2.5° vs. 6.5° at 2 years, p = 0.04, respectively). Cage subsidence was significantly less in Group L than in Group C (29% vs. 80%, p < 0.001). LAVR using a rectangular footplate cage is an effective treatment for OVF to minimize surgical invasiveness and postoperative correction loss.
Highlights
The incidence of osteoporotic vertebral fracture (OVF) increases with age [1]
We found that correction loss and cage subsidence were significantly smaller in lateral access vertebral reconstruction (LAVR) at 1 year and 2 years postoperatively
minimally invasive surgery (MIS) LAVR was more effective for OVF treatment
Summary
The incidence of osteoporotic vertebral fracture (OVF) increases with age [1]. Some patients have difficulty returning to activities of daily living because of severe back pain or neurological complications with pseudarthrosis [2,3] even with conservative treatment, which results in OVF posing a significant cost to society. Contraindications to balloon kyphoplasty include pedicle fracture and fracture of the posterior wall of the vertebral body diagnosed on computed tomography (CT); these cases require reconstructive surgery [4]. Various reconstructive surgical techniques have been reported for OVF, including anterior reconstruction surgery, posterior fusion with or without vertebroplasty, and anterior–posterior combined surgery (AP surgery) [5,6,7,8], the best method has not yet been identified [9]. Anterior surgery alone results in the need for additional surgery rather than maintaining alignment and provides inadequate fixation, especially for patients with severe osteoporosis [7]. To avoid correction loss and instrumentation failure, AP surgery is more effective than posterior fusion with vertebroplasty [11]. The risk of correction loss and nonunion still cannot be eliminated [11]
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