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Selecting proper distal fusion level in severe thoracolumbar kyphosis secondary to late osteoporotic vertebral compression fracture to limit distal complications

  • Author Footnotes
    1 Yu Wang and Weiguo Zhu contributed equally to this work.
    Yu Wang
    Footnotes
    1 Yu Wang and Weiguo Zhu contributed equally to this work.
    Affiliations
    Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China

    National Clinical Research Center for Geriatric Diseases, Beijing, China
    Search for articles by this author
  • Author Footnotes
    1 Yu Wang and Weiguo Zhu contributed equally to this work.
    Weiguo Zhu
    Footnotes
    1 Yu Wang and Weiguo Zhu contributed equally to this work.
    Affiliations
    Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China

    National Clinical Research Center for Geriatric Diseases, Beijing, China
    Search for articles by this author
  • Kang Sun
    Affiliations
    Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China

    National Clinical Research Center for Geriatric Diseases, Beijing, China
    Search for articles by this author
  • Chao Kong
    Affiliations
    Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China

    National Clinical Research Center for Geriatric Diseases, Beijing, China
    Search for articles by this author
  • Wei Wang
    Affiliations
    Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China

    National Clinical Research Center for Geriatric Diseases, Beijing, China
    Search for articles by this author
  • Shibao Lu
    Correspondence
    Corresponding author. Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Changchun Road No. 45, Beijing, 100053, China.
    Affiliations
    Department of Orthopaedic Surgery, Capital Medical University Xuanwu Hospital, Beijing, China

    National Clinical Research Center for Geriatric Diseases, Beijing, China
    Search for articles by this author
  • Author Footnotes
    1 Yu Wang and Weiguo Zhu contributed equally to this work.
Published:September 14, 2021DOI:https://doi.org/10.1016/j.jos.2021.07.025

      Abstract

      Background

      Surgical treatment of severe thoracolumbar kyphosis (TLK) secondary to late osteoporotic vertebral compression fracture (OVCF) presents several challenges to spine surgeons. Proper selection of distal fusion level is an important issue in surgical planning to decrease the likelihood of distal mechanical complications. This study was designed to compare the clinical and radiographic outcomes in elderly patients suffering from severe TLK related with late OVCF between different distal fusion strategies and to recommend a superior distal fusion level for these patients.

      Methods

      A total of 57 consecutive subjects with a minimum follow-up of two years were retrospectively reviewed. TLK was defined as the hyperkyphosis with an apex below T10. Severe TLK was defined as the Cobb angle of kyphosis ≥60°. Patients fused to sagittal stable vertebra (SSV) were assigned to Group SSV, while those fused to the vertebra above and below SSV were assigned to Groups SSV- and SSV+, respectively. Bone cement was used to enhance pedicle screw fixation. Clinical and radiographic results were collected and compared between different groups.

      Results

      Deformity corrections and living quality improvements at the latest follow-up were superior in Group SSV than Group SSV- with shorter fusion levels, while to the equal extent with Group SSV+ with longer fusion levels. 7 cases of distal complications were observed in Group SSV-. Negatively balanced lowest instrumented vertebra was revealed to be the independent factor predicting distal complications. Patients’ satisfaction of their surgical management was greater in Group SSV than Group SSV- (83.2 ± 4.4% vs. 70.5 ± 10.9%, P = 0.024), while comparable with Groups SSV + SSV+ (84.8 ± 5.7%).

      Conclusions

      Fusion to SSV with cement-augmented pedicle screws could limit the development of distal junctional mechanical complications after surgical treatment for severe TLK secondary to late OVCF in elderly patients, while achieves satisfactory deformity correction with the preservation of necessary lumbar motility.
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