Abstract
Recently, an expandable cage equipped with rectangular footplates has been used for anterior vertebral replacement in osteoporotic vertebral fracture (OVF). However, the postoperative changes in global alignment have not been elucidated. The purpose of this study was to evaluate local and global spinal alignment after anterior and posterior spinal fixation (APSF) using an expandable cage in elderly OVF patients. This retrospective multicenter review assessed 54 consecutive patients who underwent APSF for OVF. Clinical outcomes were compared between postoperative sagittal vertical axis (SVA) > 95 mm and ≤95 mm groups to investigate the impact of malalignment. SVA improved by only 18.7 mm (from 111.8 mm to 93.1 mm). VAS score of back pain at final follow-up was significantly higher in patients with SVA > 95 mm than SVA ≤ 95 mm (42.4 vs. 22.6, p = 0.007). Adjacent vertebral fracture after surgery was significantly more frequent in the SVA > 95 mm (37% vs. 11%, p = 0.038). Multiple logistic regression showed significantly increased OR for developing adjacent vertebral fracture (OR = 4.76, 95% CI 1.10–20.58). APSF using the newly developed cage improves local kyphotic angle but not SVA. The main cause for the spinal malalignment after surgery was postoperative development of adjacent vertebral fractures.
Highlights
Adjacent vertebral fracture after surgery was significantly more frequent in the sagittal vertical axis (SVA) > 95 mm group than in the SVA ≤ 95 mm group (37% vs. 11%, p = 0.038)
TPA, T1 Pelvic Angle; OR, odds ratio. * The odds ratio was adjusted for age, preoperative TPA and adjacent vertebral fracture. This is the first study to reveal details about changes in sagittal balance following the minimally invasive procedure of corpectomy and reconstruction using an expandable cage with rectangular foot plates (APSF)
It is reported that anatomical and biomechanical restoration of vertebra is an advantage of anterior surgery resulting from the placement of anterior struts, our results indicated that restoration of sagittal alignment was not achieved by anterior surgery with 1–2 level posterior fixation in osteoporotic vertebral fracture (OVF) patients
Summary
Many mechanisms work together to maintain balance in the normal spine and extremities, including some compensatory mechanisms. Other reports have shown that osteoporotic vertebral fracture (OVF) is strongly related to sagittal spinal imbalance in aged patients [3,4,5]. Several reports suggest that reduced muscle volume (i.e., sarcopenia) is one of the major causes of sagittal imbalance, causing reduction in the QOL of OVF patients [6,7,8]. With the aging of society and the associated increase in the amount of osteosarcopenia [11], the number of patients presenting with problems associated with an imbalanced sagittal spine is likely to increase in the near future
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