title: Posterior-approach vertebral replacement with rectangular parallelepiped cages (PAVREC) for the treatment of osteoporotic vertebral collapse with neurological deficits.
abstract: METHODS
  A retrospective clinical study.
  
  
  OBJECTIVE
  To assess the efficacy of a new spinal reconstruction technique (posterior-approach vertebral replacement with rectangular parallelepiped cages: PAVREC) for the treatment of osteoporotic late vertebral collapse with neurological deficits.
  
  
  BACKGROUND
  Poor bone quality and medically complicated situations obfuscate precise treatment for paraplegia caused by osteoporotic vertebral collapse. Recently, posterior-approach corpectomy and replacement with a cylindrical cage have been proposed. However, postoperative cage subsidence and kyphosis progression frequently occurs.
  
  
  METHODS
  Surgical invasiveness, perioperative complications, and clinical and radiographic outcomes in a total of 19 consecutive patients with osteoporosis (7 men and 12 women; mean age, 75 y) who underwent PAVREC with a mean follow-up period of 45.6 months (range, 16-79 mo) were reviewed. The affected vertebral levels ranged from T12-L4. The mean bone mineral density of the femoral neck was 0.611±0.077 g/cm(2) (mean±SD).
  
  
  RESULTS
  Mean operative time was 261 minutes (range, 155-326 min). Mean blood loss was 664 mL (range, 197-1595 mL). There were no reported surgical complications. Neurological deficits evaluated with the Frankel grading score improved >1 grade after surgery in all patients. Mean preoperative visual analog scale scores for back or leg pain (7.2; range, 6-9) significantly improved after surgery (1.4; range, 0-2) (P<0.05). Local kyphosis improved from a mean of 24.6 degrees before surgery to a mean of 1.5 degrees after surgery (P< 0.05), and it was maintained at a mean of 2.5 degrees at the final follow-up. Although screw loosening, cage subsidence, and subsequent vertebral fracture were seen in several cases, no additional surgeries were needed. Solid bony fusion was confirmed in all cases.
  
  
  CONCLUSIONS
  PAVREC provided a satisfactory clinical and radiologic outcome without severe complications. This procedure can be a treatment option for osteoporotic vertebral collapse and an alternative to an anterior-approach or single posterior-approach reconstruction with a cylindrical cage.
authors: Department of Orthopedic Surgery, Akita Kumiai General Hospital, Akita, Japan. suzuki-te@archosp-1998.com
authors: Tetsuya
authors: T
authors: Suzuki
authors: Eiji
authors: E
authors: Abe
authors: Naohisa
authors: N
authors: Miyakoshi
authors: Hajime
authors: H
authors: Murai
authors: Takashi
authors: T
authors: Kobayashi
authors: Toshiki
authors: T
authors: Abe
authors: Kazuma
authors: K
authors: Kikuchi
authors: Yoichi
authors: Y
authors: Shimada
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000601:surgery*; D010264:Paraplegia / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*