title: Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures.
abstract: OBJECTIVE Vertebroplasty and balloon kyphoplasty are effective treatment options for osteoporotic vertebral compression fractures but are limited in correction of kyphotic deformity. Lordoplasty has been reported as an alternative, cost-effective, minimally invasive, percutaneous cement augmentation technique with good restoration of vertebral body height and alignment. The authors report on its clinical and radiological midterm results. METHODS A retrospective review was conducted of patients treated with lordoplasty from 2002 to 2014. Inclusion criteria were clinical and radiological follow-up evaluations longer than 24 months. Radiographs were accessed regarding initial correction and progressive loss of reduction. Complications and reoperations were recorded. Actual pain level, pain relief immediately after surgery, autonomy, and subjective impression of improvement of posture were assessed by questionnaire. RESULTS Sixty-five patients (46 women, 19 men, age range 38.9-86.2 years old) were treated with lordoplasty for 69 vertebral compression and insufficiency fractures. A significant correction of the vertebral kyphotic angle (mean 13°) and segmental kyphotic angle (mean 11°) over a mean follow-up of 33 months (range 24-108 months) was achieved (p < 0.001). On average, pain was relieved to 90% of the initial pain level. In 24% of the 65 patients a second spinal intervention was necessary: 16 distant (24.6%) and 7 adjacent (10.8%) new osteoporotic fractures, 4 instrumented stabilizations (6.2%), 1 new adjacent traumatic fracture (1.5%), and 1 distant microsurgical decompression (1.5%). Cement leakage occurred in 10.4% but was only symptomatic in 1 case. CONCLUSIONS Lordoplasty appeared safe and effective in midterm pain alleviation and restoration of kyphotic deformity in osteoporotic compression and insufficiency fractures. The outcomes of lordoplasty are consistent with other augmentation techniques.
authors.affiliation: Department of Orthopedic Surgery, Inselspital, and.
authors.forename: Sven
authors.initials: S
authors.lastname: Hoppe
authors.affiliation: Department of Orthopedic Surgery, Inselspital, and.
authors.forename: Mathias
authors.initials: M
authors.lastname: Budmiger
authors.affiliation: Department of Orthopedic Surgery, Inselspital, and.
authors.forename: Philipp
authors.initials: P
authors.lastname: Bissig
authors.affiliation: Institute for Evaluative Research in Medicine, University of Bern, Switzerland.
authors.forename: Emin
authors.initials: E
authors.lastname: Aghayev
authors.affiliation: Department of Orthopedic Surgery, Inselspital, and.
authors.forename: Lorin M
authors.initials: LM
authors.lastname: Benneker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010146:Pain / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome
keywords: BKA = bisegmental kyphotic angle; BKP = balloon kyphoplasty; SKA = segmental kyphotic angle; VBS = vertebral body stenting; VCF = vertebral compression fracture; VKA = vertebral kyphotic angle; cement augmentation; kyphotic correction; lordoplasty; osteoporosis; technique; vertebral compression fracture