Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebral collapse.
METHODS
A retrospective study.


OBJECTIVE
To investigate the clinical and radiographic results of spinal reconstruction using Kaneda anterior spinal instrumentation for osteoporotic vertebral collapse.


BACKGROUND
Recent advances in osteoporotic vertebral fracture treatment including kyphoplasty changes the role of major surgery for these pathologies. However, osteoporotic vertebral collapse with neurologic compromise remains requiring surgical decompression and reconstruction.


METHODS
Thirty-one consecutive patients who underwent anterior spinal reconstruction for osteoporotic vertebral collapse with neurologic deficits were reviewed retrospectively. Twenty-six patients had single vertebral collapse and 5 had multiple lesions. They were 10 males and 21 females with mean age of 71 years. Mean follow-up period was 57 months. For anterior column support, iliac bone graft was used in 1 patient, cylindrical titanium cages in 12, and bioactive ceramic spacers in 18 patients. Kaneda anterior instrumentation was used in all the patients. Radiographic and clinical assessments were performed preoperatively and at the final follow-up.


RESULTS
All the patients showed neurologic recovery. Visual analog scales (0 to 10) of low back pain and sciatic pain were 5.8 and 4.2 before surgery, and 2.1 and 0.6 at the final follow-up, respectively. Mean kyphosis of operative levels was 31 degrees before surgery, and improved to 13 degrees immediately after surgery and 21 degrees at the final follow-up. Posterior reinforcement was required in 6 patients (19%), who had severe osteoporosis and/or underwent multilevel corpectomies. Solid fusion was achieved in all patients at the final follow-up.


CONCLUSIONS
The current study demonstrated the advantages of anterior spinal reconstruction in osteoporotic vertebral collapse: (1) safe and reliable decompression could be performed, and (2) 80% of patients were successfully treated with anterior spinal reconstruction alone. However, patients with multilevel corpectomies and/or severe osteoporosis highly required posterior reinforcement.
Kanayama
Masahiro
M
Spine Center, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan. mkanayama@aol.com
Ishida
Takashi
T
Hashimoto
Tomoyuki
T
Shigenobu
Keiichi
K
Togawa
Daisuke
D
Oha
Fumihiro
F
Kaneda
Kiyoshi
K
D000368:Aged; D001672:Biocompatible Materials; D016025:Bone Transplantation / Q000379:methods; D002516:Ceramics / Q000627:therapeutic use; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000706:statistics & numerical data*; D008297:Male; D010024:Osteoporosis / Q000150:complications*; D019736:Prostheses and Implants; D011474:Prosthesis Design; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014025:Titanium / Q000627:therapeutic use; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000295:instrumentation* / Q000379:methods
D001672:Biocompatible Materials; D014025:Titanium