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Anterior versus posterior surgery for osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine.
- Source :
-
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society [Eur Spine J] 2006 Dec; Vol. 15 (12), pp. 1759-67. Date of Electronic Publication: 2006 May 05. - Publication Year :
- 2006
-
Abstract
- Despite the increasing number of reports on surgical treatments for thoracolumbar osteoporotic vertebral collapse with neurological deficits, the choice of surgery remains controversial. In this retrospective study, we compared the outcomes of posterior and anterior surgeries for single-level osteoporotic vertebral collapse with neurological deficit in the thoracolumbar spine. Both posterior and anterior surgical approaches were performed with a consistent procedure for a single surgical indication at one institution. Twenty-four patients treated with posterior surgery and 28 patients treated with anterior surgery were followed-up over an average of 5 years after surgery. Radiographic results (kyphotic angle, bony fusion, and instrumentation failure), neurological improvement, and surgical complications were compared between the two groups. The average correction angle after surgery was larger in the posterior group than in the anterior group (P = 0.013), but not at final follow-up (P = 0.755). The average loss of correction was also higher in the posterior group than in the anterior group (P = 0.037). There was no significant difference in neurological outcomes between anterior and posterior approaches (P = 0.080). Two-way analysis of variance (ANOVA) showed that the neurological outcome was better in wedge type than in flat type vertebral collapse, regardless of the type of surgical approach (P = 0.0093). In wedge type vertebral collapse, neurological improvement tended to be greater after anterior than after posterior surgery. In four of six cases with instrumentation failure in the anterior group, a titanium cage subsided more than 5 mm but bony fusion was eventually achieved without causing neurological problems. In the posterior group, six cases experienced instrumentation failure during the postoperative course (two cases with screws loosened from pedicles and bodies, and one case with breakage of a screw neck). None of the patients developed instrumentation-related neurological problems. Two cases in each group developed pseudoarthrosis. In single-level osteoporotic vertebral collapse with neurological deficit, anterior surgery tended to improve neurological deficit in wedge type, but not in flat type collapse, compared with posterior surgery.
- Subjects :
- Aged
Aged, 80 and over
Decompression, Surgical
Female
Fractures, Spontaneous diagnostic imaging
Fractures, Spontaneous pathology
Fractures, Spontaneous surgery
Humans
Kyphosis diagnostic imaging
Kyphosis pathology
Kyphosis surgery
Lumbar Vertebrae diagnostic imaging
Lumbar Vertebrae surgery
Male
Middle Aged
Nervous System Diseases etiology
Osteoporosis diagnostic imaging
Osteoporosis pathology
Postoperative Complications
Prostheses and Implants
Radiography
Retrospective Studies
Spinal Fractures diagnostic imaging
Spinal Fractures pathology
Thoracic Vertebrae diagnostic imaging
Thoracic Vertebrae surgery
Lumbar Vertebrae injuries
Osteoporosis complications
Spinal Fractures surgery
Spinal Fusion methods
Thoracic Vertebrae injuries
Subjects
Details
- Language :
- English
- ISSN :
- 0940-6719
- Volume :
- 15
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
- Publication Type :
- Academic Journal
- Accession number :
- 16676156
- Full Text :
- https://doi.org/10.1007/s00586-006-0106-z