Abstract
PurposeIn the surgical treatment of osteoporotic spine fractures, there is no clear recommendation, which treatment is best for the individual patient with vertebra plana and/or neurological deficit requiring instrumentation. The aim of this study was to evaluate clinical and radiological outcomes after dorsal or 360° instrumentation of osteoporotic fractures of the thoracolumbar spine in a cohort of patients representing clinical reality.MethodsA total of 116 consecutive patients were operated on between 2008 and 2020. Inclusion criteria were osteoporotic fracture, thoracolumbar location, and dorsal instrumentation. In 79 cases, vertebral body replacement (VBR) was performed additionally. Patient outcomes including complications, EQ-5D at follow-up, and sagittal correction were analyzed.ResultsMedical and surgical complications occurred in 59.5% of patients with 360° instrumentation compared to 64.9% of patients with dorsal instrumentation only (p = 0.684). Dorsal instrumentation plus VBR resulted in a sagittal correction of 9.3 ± 7.4° (0.1–31.6°) compared to 6.0 ± 5.6° (0.2–22.8°) after dorsal instrumentation only, respectively (p = 0.0065). EQ-5D was completed by 79 patients after 4.00 ± 2.88 years (0.1–11.8 years) and was 0.56 ± 0.32 (− 0.21–1.00) for VBR compared to 0.56 ± 0.34 (− 0.08–1.00) without VBR after dorsal instrumentation (p = 0.994).Conclusion360° instrumentation represents a legitimate surgical technique with no additional morbidity even for the elderly and multimorbid osteoporotic population. Particularly, if sufficient long-term construct stability is in doubt or ventral stenosis is present, there is no need to abstain from additional ventral reinforcement and decompression.
Highlights
Osteoporosis is a systemic disease characterized by reduced bone mass and disruption of bone architecture, resulting in an increased risk of fragility fractures which represent the main clinical consequence of the disease [1, 2]
The aim of this study was to examine the clinical and radiological outcomes of patients with osteoporotic fractures of the thoracic and lumbar spine treated with or without a combined 360° instrumentation based on the mentioned classifications as stratification
Our hypothesis is that if sufficient long-term construct stability is in doubt after dorsal instrumentation or ventral stenosis is present, additional ventral reinforcement and decompression via 360° instrumentation are feasible and safe and offer a viable option
Summary
Osteoporosis is a systemic disease characterized by reduced bone mass and disruption of bone architecture, resulting in an increased risk of fragility fractures which represent the main clinical consequence of the disease [1, 2]. Most osteoporotic vertebral fractures are treated conservatively with bed rest, analgesics, bracing, early rehabilitation, and osteoporosis treatment with bisphosphonates [7, 8]. In some patients the fracture healing is impaired, leading to major complications such as pseudarthrosis, final vertebral collapse, spinal deformity, and spinal cord compression. These complications are rare, they are strongly related to poor prognosis, prolonged back pain, strong impairment of daily living activities, and reduced quality of life [9]
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