File Download

There are no files associated with this item.

  Links for fulltext
     (May Require Subscription)
Supplementary

Article: Open vertebral cement augmentation combined with lumbar decompression for the operative management of thoracolumbar stenosis secondary to osteoporotic burst fractures

TitleOpen vertebral cement augmentation combined with lumbar decompression for the operative management of thoracolumbar stenosis secondary to osteoporotic burst fractures
Authors
KeywordsBurst fractures
Cement augmentation
Inflatable bone tamp
Kyphoplasty
Osteoporosis
Percutaneous vertebroplasty
Thoracolumbar
Issue Date2005
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.jspinaldisorders-tech.com
Citation
Journal Of Spinal Disorders And Techniques, 2005, v. 18 n. 5, p. 413-419 How to Cite?
AbstractOsteoporotic burst fractures with neurologic symptoms are typically treated with neural decompression and multilevel instrumented fusion. These large surgical interventions are challenging because of patients' advanced ages, medical co-morbidities, and poor fixation secondary to osteoporosis. The purpose of this retrospective clinical study was to describe a novel technique for the treatment of osteoporotic burst fractures and symptomatic spinal stenosis via a limited thoracolumbar decompression with open cement augmentation [vertebroplasty (VP) or kyphoplasty (KP)]. Indications for decompression and cement augmentation were intractable pain at the level of a known osteoporotic burst fracture with symptoms of spinal stenosis. As such, 25 patients (mean age, 76.1 years) with low-energy, osteoporotic, thoracolumbar burst fractures (7 males, 18 females; 39 fractures) were included. In all cases, laminectomy of the stenotic level(s) was followed by vertebral cement augmentation (9 VP; 16 KP). When a spondylolisthesis at the decompressed level was present, instrumentation was applied across the listhetic level (n = 9). Clinical outcome (1 = poor to 4 = excellent) was assessed on last clinical follow-up (mean, 44.8 wks). In addition, a modified MacNab's grading criteria was used to objectively assess patient outcomes postoperatively. Radiographic analysis of sagittal contour was assessed preoperatively, immediately postoperatively, and at final follow-up. The average time from onset of symptoms to intervention was 19 weeks (range, 0.3-94 wks). A mean of 1.6 fractures/patient was augmented (range, 1-3 fractures) and 2.8 levels were decompressed (range, 1-6 levels). No statistical difference in anatomic distribution or number of fractures between the VP and KP groups or in the instrumented versus noninstrumented patients was noted (P > 0.05). An overall subjective outcome score of 3.4 was noted. Twenty of 25 patients were graded as excellent/good according to the modified MacNab's criteria. The choice of augmentation procedure or use of instrumentation did not predict outcome (P = 0.08). Overall, 1.7 degrees of sagittal correction was obtained at final follow-up. One patient was noted to have progressive kyphosis after KP. The use of a limited-posterior decompression and open cement augmentation via VP or KP is a safe treatment option for patients who have osteoporotic burst fractures and who are incapacitated from fracture pain and concomitant stenosis. After thoracolumbar decompression, open VP/KP provides direct visualization of the posterior vertebral body wall, allowing for safe cement augmentation of burst fractures, stabilizing the spine, and obviating the need for extensive spinal reconstruction. Although clinically successful, this technique warrants careful patient selection. Copyright © 2005 by Lippincott Williams & Wilkins.
Persistent Identifierhttp://hdl.handle.net/10722/92927
ISSN
2015 Impact Factor: 2.291
2015 SCImago Journal Rankings: 0.798
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorSingh, Ken_HK
dc.contributor.authorHeller, JGen_HK
dc.contributor.authorSamartzis, Den_HK
dc.contributor.authorPrice, JSen_HK
dc.contributor.authorAn, HSen_HK
dc.contributor.authorYoon, STen_HK
dc.contributor.authorRhee, Jen_HK
dc.contributor.authorLedlie, JTen_HK
dc.contributor.authorPhillips, FMen_HK
dc.date.accessioned2010-09-22T05:04:01Z-
dc.date.available2010-09-22T05:04:01Z-
dc.date.issued2005en_HK
dc.identifier.citationJournal Of Spinal Disorders And Techniques, 2005, v. 18 n. 5, p. 413-419en_HK
dc.identifier.issn1536-0652en_HK
dc.identifier.urihttp://hdl.handle.net/10722/92927-
dc.description.abstractOsteoporotic burst fractures with neurologic symptoms are typically treated with neural decompression and multilevel instrumented fusion. These large surgical interventions are challenging because of patients' advanced ages, medical co-morbidities, and poor fixation secondary to osteoporosis. The purpose of this retrospective clinical study was to describe a novel technique for the treatment of osteoporotic burst fractures and symptomatic spinal stenosis via a limited thoracolumbar decompression with open cement augmentation [vertebroplasty (VP) or kyphoplasty (KP)]. Indications for decompression and cement augmentation were intractable pain at the level of a known osteoporotic burst fracture with symptoms of spinal stenosis. As such, 25 patients (mean age, 76.1 years) with low-energy, osteoporotic, thoracolumbar burst fractures (7 males, 18 females; 39 fractures) were included. In all cases, laminectomy of the stenotic level(s) was followed by vertebral cement augmentation (9 VP; 16 KP). When a spondylolisthesis at the decompressed level was present, instrumentation was applied across the listhetic level (n = 9). Clinical outcome (1 = poor to 4 = excellent) was assessed on last clinical follow-up (mean, 44.8 wks). In addition, a modified MacNab's grading criteria was used to objectively assess patient outcomes postoperatively. Radiographic analysis of sagittal contour was assessed preoperatively, immediately postoperatively, and at final follow-up. The average time from onset of symptoms to intervention was 19 weeks (range, 0.3-94 wks). A mean of 1.6 fractures/patient was augmented (range, 1-3 fractures) and 2.8 levels were decompressed (range, 1-6 levels). No statistical difference in anatomic distribution or number of fractures between the VP and KP groups or in the instrumented versus noninstrumented patients was noted (P > 0.05). An overall subjective outcome score of 3.4 was noted. Twenty of 25 patients were graded as excellent/good according to the modified MacNab's criteria. The choice of augmentation procedure or use of instrumentation did not predict outcome (P = 0.08). Overall, 1.7 degrees of sagittal correction was obtained at final follow-up. One patient was noted to have progressive kyphosis after KP. The use of a limited-posterior decompression and open cement augmentation via VP or KP is a safe treatment option for patients who have osteoporotic burst fractures and who are incapacitated from fracture pain and concomitant stenosis. After thoracolumbar decompression, open VP/KP provides direct visualization of the posterior vertebral body wall, allowing for safe cement augmentation of burst fractures, stabilizing the spine, and obviating the need for extensive spinal reconstruction. Although clinically successful, this technique warrants careful patient selection. Copyright © 2005 by Lippincott Williams & Wilkins.en_HK
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.jspinaldisorders-tech.comen_HK
dc.relation.ispartofJournal of Spinal Disorders and Techniquesen_HK
dc.subjectBurst fracturesen_HK
dc.subjectCement augmentationen_HK
dc.subjectInflatable bone tampen_HK
dc.subjectKyphoplastyen_HK
dc.subjectOsteoporosisen_HK
dc.subjectPercutaneous vertebroplastyen_HK
dc.subjectThoracolumbaren_HK
dc.titleOpen vertebral cement augmentation combined with lumbar decompression for the operative management of thoracolumbar stenosis secondary to osteoporotic burst fracturesen_HK
dc.typeArticleen_HK
dc.identifier.emailSamartzis, D:dspine@hku.hken_HK
dc.identifier.authoritySamartzis, D=rp01430en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/01.bsd.0000173840.59099.06en_HK
dc.identifier.scopuseid_2-s2.0-33644816006en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-33644816006&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume18en_HK
dc.identifier.issue5en_HK
dc.identifier.spage413en_HK
dc.identifier.epage419en_HK
dc.identifier.isiWOS:000236557500007-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridSingh, K=7404762677en_HK
dc.identifier.scopusauthoridHeller, JG=7201486435en_HK
dc.identifier.scopusauthoridSamartzis, D=34572771100en_HK
dc.identifier.scopusauthoridPrice, JS=24330069200en_HK
dc.identifier.scopusauthoridAn, HS=7202277351en_HK
dc.identifier.scopusauthoridYoon, ST=7404036396en_HK
dc.identifier.scopusauthoridRhee, J=7202839338en_HK
dc.identifier.scopusauthoridLedlie, JT=36861226600en_HK
dc.identifier.scopusauthoridPhillips, FM=7102508318en_HK

Export via OAI-PMH Interface in XML Formats


OR


Export to Other Non-XML Formats