Surgical strategy using lateral access surgery for kyphotic deformity after osteoporotic vertebral fracture

• Published in: Journal of Spine Research Vol. 14; no. 10; pp. 1308 - 1317
• Main Authors: Ishida, Hiroaki, Kawashima, Koki, Paku, Masaaki, Masada, Kohei, Ishihara, Masayuki, Tanaka, Takahiro, Ando, Muneharu, Taniguchi, Shinichiro, Adachi, Takashi, Saito, Takanori, Tani, Yoichi
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society for Spine Surgery and Related Research 20.10.2023; 一般社団法人 日本脊椎脊髄病学会
• Subjects: lateral access surgery; osteoporotic vertebral fracture; percutaneous pedicle screw; 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
• ISSN: 1884-7137; 2435-1563
• DOI: 10.34371/jspineres.2023-1007

Purpose: To investigate the clinical results of lateral access surgery (LAS) such as lateral route lumbar interbody fusion (LLIF), lateral access corpectomy (LAC), and anterior column realignment (ACR) for osteoporotic vertebral fracture (OVF).Subjects and methods: Twenty-three patients who underwent LAS for KDOVF at our hospital after 2019 and were able to follow up for at least 18 months were included in the study. Surgical method, fractured vertebral body level, local kyphotic angle, number of fixed vertebral bodies, bone fusion rate, using of cement augmentation (CA), and complications were evaluated.Results: LLIF was performed in 6 cases (Group L), LAC in 14 cases (Group C), and ACR in 3 cases (Group A). Fractured vertebrae were L1 to L4 in Group L, T12 and L1 in Group C, and only L2 and 3 in Group A. The blood loss and operative time were significantly higher in Group C, and there was no significant difference in the number of fixed vertebra in the three groups. Changes in local kyphotic angle were significantly improved after surgery in all three groups. Correction loss was about 1 degree in Group L, 2.4 degrees in Group C, and 3 degrees in Group A, and was significantly lower in Group L. The average correction angle was 11 degrees for Group L, 25 degrees for Group C, and 18 degrees for Group A, and Group C was significantly larger than Group L. The bone fusion rate 12 months after surgery in Group A was the lowest, but the bone fusion rate 24 months after surgery was more than 90% in all three groups. Complications were endplate injury in one case each of Group C, and cage subsidence in one case of Group A. In the Group C, 4 cases of pleural injury and 1 case of proximal junctional failure (PJF) were observed, but no cases required reoperation.Conclusion: The clinical results of LAS for OVF was investigated. Good results were obtained in all three groups. In this study, it was suggested that LAS is a useful surgical technique for OVF kyphotic deformity with severe bone fragility.