Abstract
Introduction: Recent increases in the prevalence of osteoporotic vertebral fractures are attributable to rapid aging of the population. Conservative treatment usually achieves successful bone fusion; however, some patients show delayed union and vertebral collapse resulting in neurological deficits and kyphotic deformities. These patients are candidates for various surgical procedures; however, surgical invasion and implant-induced complications can occur. The X-core2® system was introduced in Japan in 2015. This device is useful for minimally invasive anterior vertebral corpectomy and vertebral replacement for osteoporotic vertebral collapse. However, the surgical procedure remains controversial. We investigated the surgical procedure and clinical outcomes in 28 consecutive patients with kyphotic deformities secondary to osteoporotic vertebral fractures (KOVF).
Patients and methods: This study included 28 patients with KOVF who underwent lateral access corpectomy (LAC) performed by the same surgeon at a single hospital between 2017 and 2018. All patients were followed-up for at least 18 months postoperatively. LAC followed by posterior thoracolumbar fixation using a percutaneous pedicle screw (PPS) was performed as corrective surgery for KOVF. The surgical procedure, number of fixed vertebral bodies, intraoperative blood loss, operative time, pre- and postoperative radiological measurements-including various spinopelvic parameters-bone fusion rates, and intra- and postoperative complications were evaluated.
Results: No patients showed bone fusion of the posterior element. All patients underwent anterior corpectomy followed by posterior fixation (AP). The mean fixed number of vertebral bodies was 5.1±0.57. The mean operation time was 207±92 min, and the mean intraoperative blood loss was 456±156 ml. The following spinopelvic parameters (pre-/postoperative) improved significantly: lumbar lordosis (LL) 28°/45°, pelvic incidence-LL 17°/2°, pelvic tilt 29°/20°, and local kyphosis angle 23.3°/−1.4°. The mean correction loss was 0.7°. The anterior interbody distance improved from 21.8 mm to 35.5 mm, and the posterior interbody distance improved from 25.4 mm to 33.7 mm. Bone union rates were 67% and 85% at 6 and 12 months, respectively. Observed complications included endplate injury (n=2), cage subsidence (n=3), proximal junctional kyphosis (n=2), distal junctional failure (n=1), and parietal pleura injury (n= 8). No patients required reoperation.
Conclusions: AP achieves good correction. Posterior fixation is possible with PPS in patients without posterior bone fusion.
