骨粗鬆症性椎体骨折後後弯変形に対するlateral access surgeryによる手術戦略
目的：骨粗鬆症性椎体骨折後後弯変形（kyphotic deformity after osteoporotic vertebral fracture KDOVF）に対する側方経路腰椎椎体間固定術（LLIF），lateral access corpectomy（LAC），anterior column realignment（ACR）等のlateral access surgery（LAS）の臨床成績を検討した．対象及び方法：2019年以降当院にてKDOVFに対してLASを行い，24ヶ月以上経過観察可能であった23名を対象とした．検討項目は手術方法，骨折椎体レベル，局所後弯角（local kyp...
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| Published in | Journal of Spine Research Vol. 14; no. 10; pp. 1308 - 1317 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脊椎脊髄病学会
20.10.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1884-7137 2435-1563 |
| DOI | 10.34371/jspineres.2023-1007 |
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| Abstract | 目的：骨粗鬆症性椎体骨折後後弯変形（kyphotic deformity after osteoporotic vertebral fracture KDOVF）に対する側方経路腰椎椎体間固定術（LLIF），lateral access corpectomy（LAC），anterior column realignment（ACR）等のlateral access surgery（LAS）の臨床成績を検討した．対象及び方法：2019年以降当院にてKDOVFに対してLASを行い，24ヶ月以上経過観察可能であった23名を対象とした．検討項目は手術方法，骨折椎体レベル，局所後弯角（local kyphosis LK），固定椎体数，骨癒合率，cement augmentation（CA）併用の有無，合併症とした．結果：術式はLLIFが6例（L群），LACが14例（C群），ACRが3例（A群）であった．骨折椎体レベルはL群でL1からL4，C群はT12，L1が最多であり，A群はL2，3のみであった．出血量及び手術時間においてC群が有意に多く，固定椎体数は3群間で有意差はなく，CAはL群及び，C群で2例，A群の1例で併用した．LKは，3群いずれも術後有意に改善した．矯正損失はL群で約1度，C群で2.4°，A群で3°でありL群で有意に低かった．最終的な平均矯正量はL群11度，C群25°，A群18°でありC群はL群と比較し有意に大きかった．骨癒合率は1年でA群が低い傾向にあったが有意差はなく，術後18ヶ月では3群とも90％以上で認めた．合併症はC群で終板損傷を1例，またcage subsidenceをA群で1例認めた．C群では胸膜損傷を4例，proximal junctional failureを1例認めたが，再手術を要した症例はなかった．結語：KDOVFに対するLASの臨床成績を調査した．3群とも概ね良好な結果がえられた．骨脆弱性の強い病態であるKDOVFに対して支持面積の大きい強力な前方支柱再建が可能であるLASは有用な術式といえる． |
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| AbstractList | 目的：骨粗鬆症性椎体骨折後後弯変形（kyphotic deformity after osteoporotic vertebral fracture KDOVF）に対する側方経路腰椎椎体間固定術（LLIF），lateral access corpectomy（LAC），anterior column realignment（ACR）等のlateral access surgery（LAS）の臨床成績を検討した．対象及び方法：2019年以降当院にてKDOVFに対してLASを行い，24ヶ月以上経過観察可能であった23名を対象とした．検討項目は手術方法，骨折椎体レベル，局所後弯角（local kyphosis LK），固定椎体数，骨癒合率，cement augmentation（CA）併用の有無，合併症とした．結果：術式はLLIFが6例（L群），LACが14例（C群），ACRが3例（A群）であった．骨折椎体レベルはL群でL1からL4，C群はT12，L1が最多であり，A群はL2，3のみであった．出血量及び手術時間においてC群が有意に多く，固定椎体数は3群間で有意差はなく，CAはL群及び，C群で2例，A群の1例で併用した．LKは，3群いずれも術後有意に改善した．矯正損失はL群で約1度，C群で2.4°，A群で3°でありL群で有意に低かった．最終的な平均矯正量はL群11度，C群25°，A群18°でありC群はL群と比較し有意に大きかった．骨癒合率は1年でA群が低い傾向にあったが有意差はなく，術後18ヶ月では3群とも90％以上で認めた．合併症はC群で終板損傷を1例，またcage subsidenceをA群で1例認めた．C群では胸膜損傷を4例，proximal junctional failureを1例認めたが，再手術を要した症例はなかった．結語：KDOVFに対するLASの臨床成績を調査した．3群とも概ね良好な結果がえられた．骨脆弱性の強い病態であるKDOVFに対して支持面積の大きい強力な前方支柱再建が可能であるLASは有用な術式といえる． |
| Author | 石田, 鴻晟 石原, 昌幸 朴, 正旭 齋藤, 貴徳 足立, 崇 谷, 陽一 田中, 貴大 政田, 亘平 安藤, 宗治 谷口, 愼一郎 川島, 康輝 |
| Author_xml | – sequence: 1 fullname: 田中, 貴大 organization: 関西医科大学整形外科学教室 – sequence: 1 fullname: 政田, 亘平 organization: 関西医科大学整形外科学教室 – sequence: 1 fullname: 石田, 鴻晟 organization: 関西医科大学整形外科学教室 – sequence: 1 fullname: 足立, 崇 organization: 関西医科大学整形外科学教室 – sequence: 1 fullname: 齋藤, 貴徳 organization: 関西医科大学整形外科学教室 – sequence: 1 fullname: 谷口, 愼一郎 organization: 関西医科大学整形外科学教室 – sequence: 1 fullname: 川島, 康輝 organization: 関西医科大学整形外科学教室 – sequence: 1 fullname: 谷, 陽一 organization: 関西医科大学整形外科学教室 – sequence: 1 fullname: 石原, 昌幸 organization: 関西医科大学整形外科学教室 – sequence: 1 fullname: 安藤, 宗治 organization: 関西医科大学整形外科学教室 – sequence: 1 fullname: 朴, 正旭 organization: 関西医科大学整形外科学教室 |
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| References | 14) Berjano P, Cecchinato R, Sinigaglia A, et al: Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study. Eur Spine J. 2015; 24 (Suppl 3): 433-438 7) Chiu YC, Tsai TT, Yang SC, et al: Impact of instrumented spinal fusion on the development of vertebral compression fracture. Medicine (Baltimore). 2016; 95 (17): e3455 6) Nguyen HV, Ludwig S, Gelb D: Osteoporotic vertebral burst fractures with neurologic compromise. J Spinal Disord Tech. 2003; 16 (1): 10-19 3) Deukmedjian AR, Dakwar E, Ahmadian A, et al: Early outcomes of minimally invasive anterior longitudinal ligament release for correction of sagittal imbalance in patients with adult spinaldeformity. Scientific World Journal. 2012; 2012: 789698. e PMC article 12) Uribe JS, Myhre SL, Youssef JA: Preservation or Restoration of Segmental and Regional Spinal Lordosis Using Minimally Invasive Interbody Fusion Techniques in Degenerative Lumbar Conditions: A Literature Review. Spine (Phila Pa 1976). 2016; 41 (Suppl 8): S50-58 16) Taiji R, Takami M, Yukawa Y, et al: A short-segment fusion strategy using a wide-foot-plate expandable cage for vertebral pseudarthrosis after an osteoporotic vertebral fracture. J Neurosurg Spine. 2020; 1-8. doi: 10.3171/2020.5.SPINE2062 4) Nakashima H, Imagama S, Yukawa Y, et al: Comparative study of 2 surgical procedures for osteoporotic delayed vertebral collapse: anterior and posterior combined surgery versus posterior spinal fusion with vertebroplasty. Spine (Phila Pa 1976). 2015; 40 (2): E120-E126 15) Segi N, Nakashima H, Kanemura T, et al: Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture. J Clin Med. 2021; 10 (23): 5664 5) Isogai N, Hosogane N, Funao H, et al: The Surgical Outcomes of Spinal Fusion for Osteoporotic Vertebral Fractures in the Lower Lumbar Spine with a Neurological Deficit. Spine Surg Relat Res. 2020; 4 (3): 199-207 10) Sudo H, Ito M, Kaneda K, et al: Anterior decompression and strut graft versus posterior decompression and pedicle screw fixation with vertebroplasty for osteoporotic thoracolumbar vertebral collapse with neurologic deficits. Spine J. 2013; 13 (12): 1726-1732 11) Morishita S, Yoshii T, Okawa A, et al: Comparison of perioperative complications between anterior fusion and posterior fusion for osteoporotic vertebral fractures in elderly patients: propensity score-matching analysis using Nationwide inpatient database. Clin Spine Surg. 2020; 33 (10): E586-E592 2) Smith WD, Dakwa E, Le TV, et al: Minimally Invasive Surgery for Traumatic Spinal Pathologies: A Mini-Open, Lateral Approach in the Thoracic and Lumbar Spine. Spine. 2010; 35: 338-346 13) Akbarnia BA, Mundis GM Jr, Moazzaz P, et al: Anterior column realignment (ACR) for focal kyphotic spinal deformity using a lateral transpsoas approach and ALL release. J Spinal Disord Tech. 2014; 27 (1): 29-39 1) Ozgur BM, Aryan HE, Pimenta L, et al: Extreme lateral interbody fusion (XLIF): A novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006; 6: 435-443 9) Kaneda K, Asano S, Hashimoto T, et al: The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis. Spine (Phila Pa 1976). 1992; 17 (8) (suppl): S295-S303 8) Tamai K, Terai H, Suzuki A, et al: Risk factors for proximal fracture following fusion surgery for osteoporotic vertebral collapse with delayed neurological deficits: a retrospective cohort study of 403 patients. Spine Surg Relat Res. 2018; 3 (2): 171-177 17) Maruo K, Tachibana T, Arizumi F, et al: Effect of Teriparatide on Subsequent Vertebral Fractures after Instrumented Fusion Surgery for Osteoporotic Vertebral Fractures with Neurological Deficits. Asian Spine J. 2019; 13 (2): 283-289. doi: 10.31616/asj.2018.0098. Epub 2018 Nov 29 |
| References_xml | – reference: 15) Segi N, Nakashima H, Kanemura T, et al: Comparison of Outcomes between Minimally Invasive Lateral Approach Vertebral Reconstruction Using a Rectangular Footplate Cage and Conventional Procedure Using a Cylindrical Footplate Cage for Osteoporotic Vertebral Fracture. J Clin Med. 2021; 10 (23): 5664 – reference: 2) Smith WD, Dakwa E, Le TV, et al: Minimally Invasive Surgery for Traumatic Spinal Pathologies: A Mini-Open, Lateral Approach in the Thoracic and Lumbar Spine. Spine. 2010; 35: 338-346 – reference: 17) Maruo K, Tachibana T, Arizumi F, et al: Effect of Teriparatide on Subsequent Vertebral Fractures after Instrumented Fusion Surgery for Osteoporotic Vertebral Fractures with Neurological Deficits. Asian Spine J. 2019; 13 (2): 283-289. doi: 10.31616/asj.2018.0098. Epub 2018 Nov 29 – reference: 4) Nakashima H, Imagama S, Yukawa Y, et al: Comparative study of 2 surgical procedures for osteoporotic delayed vertebral collapse: anterior and posterior combined surgery versus posterior spinal fusion with vertebroplasty. Spine (Phila Pa 1976). 2015; 40 (2): E120-E126 – reference: 8) Tamai K, Terai H, Suzuki A, et al: Risk factors for proximal fracture following fusion surgery for osteoporotic vertebral collapse with delayed neurological deficits: a retrospective cohort study of 403 patients. Spine Surg Relat Res. 2018; 3 (2): 171-177 – reference: 9) Kaneda K, Asano S, Hashimoto T, et al: The treatment of osteoporotic-posttraumatic vertebral collapse using the Kaneda device and a bioactive ceramic vertebral prosthesis. Spine (Phila Pa 1976). 1992; 17 (8) (suppl): S295-S303 – reference: 14) Berjano P, Cecchinato R, Sinigaglia A, et al: Anterior column realignment from a lateral approach for the treatment of severe sagittal imbalance: a retrospective radiographic study. Eur Spine J. 2015; 24 (Suppl 3): 433-438 – reference: 6) Nguyen HV, Ludwig S, Gelb D: Osteoporotic vertebral burst fractures with neurologic compromise. J Spinal Disord Tech. 2003; 16 (1): 10-19 – reference: 10) Sudo H, Ito M, Kaneda K, et al: Anterior decompression and strut graft versus posterior decompression and pedicle screw fixation with vertebroplasty for osteoporotic thoracolumbar vertebral collapse with neurologic deficits. Spine J. 2013; 13 (12): 1726-1732 – reference: 5) Isogai N, Hosogane N, Funao H, et al: The Surgical Outcomes of Spinal Fusion for Osteoporotic Vertebral Fractures in the Lower Lumbar Spine with a Neurological Deficit. Spine Surg Relat Res. 2020; 4 (3): 199-207 – reference: 16) Taiji R, Takami M, Yukawa Y, et al: A short-segment fusion strategy using a wide-foot-plate expandable cage for vertebral pseudarthrosis after an osteoporotic vertebral fracture. J Neurosurg Spine. 2020; 1-8. doi: 10.3171/2020.5.SPINE2062 – reference: 7) Chiu YC, Tsai TT, Yang SC, et al: Impact of instrumented spinal fusion on the development of vertebral compression fracture. Medicine (Baltimore). 2016; 95 (17): e3455 – reference: 1) Ozgur BM, Aryan HE, Pimenta L, et al: Extreme lateral interbody fusion (XLIF): A novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006; 6: 435-443 – reference: 11) Morishita S, Yoshii T, Okawa A, et al: Comparison of perioperative complications between anterior fusion and posterior fusion for osteoporotic vertebral fractures in elderly patients: propensity score-matching analysis using Nationwide inpatient database. Clin Spine Surg. 2020; 33 (10): E586-E592 – reference: 3) Deukmedjian AR, Dakwar E, Ahmadian A, et al: Early outcomes of minimally invasive anterior longitudinal ligament release for correction of sagittal imbalance in patients with adult spinaldeformity. Scientific World Journal. 2012; 2012: 789698. e PMC article – reference: 12) Uribe JS, Myhre SL, Youssef JA: Preservation or Restoration of Segmental and Regional Spinal Lordosis Using Minimally Invasive Interbody Fusion Techniques in Degenerative Lumbar Conditions: A Literature Review. Spine (Phila Pa 1976). 2016; 41 (Suppl 8): S50-58 – reference: 13) Akbarnia BA, Mundis GM Jr, Moazzaz P, et al: Anterior column realignment (ACR) for focal kyphotic spinal deformity using a lateral transpsoas approach and ALL release. J Spinal Disord Tech. 2014; 27 (1): 29-39 |
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| SubjectTerms | 側方侵入手術 経皮的椎弓根スクリュー 骨粗鬆症性椎体骨折 |
| Title | 骨粗鬆症性椎体骨折後後弯変形に対するlateral access surgeryによる手術戦略 |
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