Anterior approach for the revision surgery following bone cement augmentation in osteoporotic vertebral compression fractures.
10.12200/j.issn.1003-0034.20230371
- Author:
Yi-Feng ZHOU
1
;
Xing ZHAO
2
Author Information
1. Medical College of Zhejiang University, Hangzhou 310000, Zhejiang, China.
2. Department of Orthopaedics, Sir Run Run Shaw Hospital, Hangzhou 310016, Zhejiang, China.
- Publication Type:Journal Article
- Keywords:
Anterior approach reconstruction;
Artificial vertebral body;
Bone cement augmentation;
Osteoporotic vertebral compression fractures;
Revision surgery
- MeSH:
Humans;
Female;
Male;
Aged;
Bone Cements;
Fractures, Compression/surgery*;
Middle Aged;
Aged, 80 and over;
Spinal Fractures/surgery*;
Osteoporotic Fractures/surgery*;
Reoperation/methods*;
Vertebroplasty
- From:
China Journal of Orthopaedics and Traumatology
2025;38(1):81-86
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To observe the clinical outcomes of anterior approach for the revision surgery following unsuccessful bone cement augmentation in osteoporotic vertebral compression fractures.
METHODS:A total of 10 patients who experienced unsuccessful bone cement augmentation underwent anterior revision surgery between January 2020 and December 2021. There were 2 males and 8 females. The age ranged from 55 to 83 years old. The reasons for revision surgery were postoperative infection in 2 cases, postoperative neurological symptoms in 3 cases, and kyphosis resulting from postoperative vertebral collapse in 5 cases. The involved segments included 2 cases of L1, 4 cases of L2, 3 cases of L3, and 1 case of L4. Among them, 2 patients underwent primary percutaneous vertebroplasty (PVP), while eight patients underwent primary percutaneous kyphoplasty (PKP). The time interval between the first and second surgeries ranged from 1 to 13 months. All patients presented with varying degrees of lumbar pain. X-ray, CT, and MRI scans were conducted prior to the revision procedure. Surgical duration, intraoperative blood loss, and any complications were documented.
RESULTS:The surgical procedures were successful in all 10 patients, with 9 cases undergoing anterior reconstruction and posterior internal fixation through the interspace of the multifidus longissimus muscle. One patient underwent anterior reconstruction and anterior plate internal fixation. The duration of the anterior approach surgery ranged from 90 to 190 minutes, with a blood loss volume ranging from 130 to 480 ml. None of the patients experienced any intraoperative or postoperative complications such as nerve injury, cerebrospinal fluid leakage, major vessel damage, abdominal organ injury, incision infection, or bleeding. The follow-up period for 10 patients ranged from 3 to 20 months. Throughout the follow-up, none of the patients experienced complications such as displacement, cutting, or loosening of the artificial vertebral body. Prior to the operation, the visual analogue scale(VAS) ranged from 4 to 8 points, the final follow-up assessment ranged from 2 to 3 points. The Oswestry disability index (ODI) score a preoperative ranged from 17% to 37%, the latest follow-up evaluation ranged from 2% to 16%. Notably, significant correction in kyphosis angle was observed in 5 cases. Furthermore, there was notable improvement in VAS and ODI compared to preoperative values.
CONCLUSION:Anterior corpectomy and artificial vertebral body implantation not only facilitate the removal of bone cement but also enable effective debridement and direct decompression. Moreover, by reconstructing anterior and middle column support, restoring vertebral height and local curvature, in combination with pedicle screw internal fixation, surgical segment stability can be achieved. Therefore, for patients requiring revision following failed bone cement augmentation, anterior surgery represents an ideal treatment option.
