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Prospective Comparative Analysis of Minimally Invasive Lumbar Posterolateral Fusion with Percutaneous Pedicle Screws vs. Conventional Approach for Degenerative Spondylolisthesis
118S
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
CONCLUSIONS: Reduction of physiological curvatures in lumbar spine led to the increased risk of vertebral fracture by more than 3 fold. Importance of evaluating sagittal spinal alignment should be emphasized because it might indicate the risk of the first vertebral fracture, which is a strong predictor of subsequent fractures. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.307
P32. Prospective Comparative Analysis of Minimally Invasive Lumbar Posterolateral Fusion with Percutaneous Pedicle Screws vs. Conventional Approach for Degenerative Spondylolisthesis Yoshihisa Kotani, MD, Manabu Ito, MD, PhD, Kuniyoshi Abumi, MD, Hideki Sudo, MD, Shigeki Oshima, MD, Yuichiro Abe, MD, Akio Minami, MD; Dept. of Orthopedic Surgery, Hokkaido University, Sapporo, Japan BACKGROUND CONTEXT: To minimize the perioperative invasiveness and improve the quality of life, we have performed the minimally invasive lumbar posterolateral fusion (MIS-PLF) with percutaneous pedicle screw fixation for degenerative spondylolisthesis. PURPOSE: This study prospectively compared the clinical result of MISPLF with that of conventional PLF (Open-PLF) with emphasis on perioperative invasiveness and patients’ quality of life. STUDY DESIGN/SETTING: Clinical prospective cohort study. PATIENT SAMPLE: The total of eighty patients received single-level PLF for lumbar degenerative spondylolisthesis. There were forty-three cases of MIS-PLF and thirty-seven cases of Open-PLF. OUTCOME MEASURES: Analyzed parameters up to two years period included the operation time, intra and postoperative blood loss, OswestryDisability Index(ODI), Roland-Morris Questionnaire (RMQ), JOA score, and VAS scores of low back pain. The fusion rate and complications were also reviewed. METHODS: The surgical technique of MIS-PLF includes 4 cm of main incision and percutaneous pedicle screwing and rod insertion. The posterolateral gutter including the medial transverse process was decorticated and iliac bone graft was performed. RESULTS: The minimum follow-up period was twelve months postoperatively (Ave. 32 months). The average length of main incision was 4.5 cm in MIS-PLF and 12 cm in open-PLF, respectively. The average operation time was statistically equivalent between two groups. The intraoperative blood loss was significantly smaller in MIS-PLF group (181 cc) when compared to open-PLF group (453 cc). The postoperative bleeding on day 1 was also smaller in MIS-PLF group (210 cc) when compared to open-PLF group (406 cc).The ODI and RMQ score rapidly decreased at initial two weeks postoperatively in MIS-PLF group, and consistently maintained lower values than those in open-PLF group at 3, 6, 12 and 24 months postoperatively. The VAS score demonstrated further rapid decreases on postoperative day 1, 3, and 7 in MIS-PLF group. The fusion rate was statistically equivalent between two groups (98% vs. 100%), and no major complications were demonstrated. CONCLUSIONS: The minimally invasive lumbar posterolateral fusion with percutaneous pedicle screw system successfully decreased the perioperative invasiveness when compared to conventional open-PLF. The reduction of postoperative pain led to early extension of ADL, demonstrating the rapid improvement of several QOL parameters. This superiority in MIS-PLF group was maintained until two-year period, suggesting better long-term effect of less invasive PLF on low back pain and QOL. The MIS-PLF utilizing percutaneous pedicle screw fixation serves as a good alternative approach, obviating the needless interbody fusion in minimally invasive approach. Even in the minimum access surgery, the use of interbody fusion can be avoided with this surgical technique. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.308
P33. Percutaneous Vertebroplasty in Very Severe Osteoporotic Vertebral Compression Fractures: Feasible and Beneficial Marc J. Nieuwenhuijse, MD, Sander P.D. Dijkstra, MD, PhD, Arian R. van Erkel, MD, PhD; Leiden University Medical Center, Leiden, Netherlands BACKGROUND CONTEXT: Patient selection criteria in Percutaneous VertebroPlasty (PVP) should be individually optimized. PVP in patients presenting with collapse of the vertebral body to less than one-third of its original height, termed vsOVCFs, is considered technically demanding and by some a relative contra-indication. Reports explicitly assessing treatment of vsOVCFs are scarce and efficacy and safety of PVP in vsOVCFs is not firmly established. PURPOSE: Establishment of clinical outcome and technical feasibility of PVP in very severe Osteoporotic Vertebral Compression Fractures (vsOVCFs). STUDY DESIGN/SETTING: Prospective (cohort) follow-up study. PATIENT SAMPLE: Thirty-seven vsOVCFs in 34 patients were identified. OUTCOME MEASURES: PI-NRS, SF-36, cement leakage on postoperative CT-scanning, complications. METHODS: Follow-up was conducted using a 0–10 Pain Intensity Numerical Rating Scale (PI-NRS) and the Short Form 36 (SF-36) quality of life questionnaire before PVP and at 7 days (PI-NRS only), 1, 3 and 12 months after PVP. Injected cement volume and cement leakage was analyzed on direct post-operative CT-scanning. At six and 52 weeks and at suspicion, patients were analyzed for new fractures. RESULTS: Thirty-seven vsOVCFs in 34 patients were identified. Decrease in PI-NRS for average and worst back pain was respectively 2.5 and 2.9 points after 7 days and 2.4 and 2.7 points after 12 months. Increase in the SF-36 Physical Component Score was significant and clinically relevant with 2.0 at one moth and 2.6 at one year, whereas the Mental Component Score showed a gradual but eventually significant and clinically relevant increase of 7.5 points. Mean injected cement volume was 3.6 mL. Cement leakage was detected in 91.9% of treated vsOVCFs. No major and one minor complication, being temporal spontaneous focal resorption of the upper adjacent disc and vertebral body after intradiscal cement leakage, occurred. CONCLUSIONS: Patients with painful very severe OVCFs benefit from PVP. Although technically more demanding and with a higher procedural risk, ie, more frequent necessity of placement of a second needle, higher leakage incidence and greater leakage volumes, PVP is technically feasible and should not be withheld from these patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.309 P34. A Clinical Comparative Study on Low vs. Medium Viscosity PMMA Bone Cement in Percutaneous Vertebroplasty: Viscosity Associated with Cement Leakage Marc J. Nieuwenhuijse, MD, Sander P.J. Muijs, MD, Arian R. van Erkel, MD, PhD, Sander P.D. Dijkstra, MD, PhD; Leiden University Medical Center, Leiden, Netherlands BACKGROUND CONTEXT: Viscosity is the main characterizing parameter of PolyMethylMetAcrylate (PMMA) bone cement, currently the standard augmentation material in Percutaneous VertebroPlasty (PVP), and influences cement interdigitation and distribution inside the vertebral body as well as injected volume and extravasation, thereby affecting the clinical outcome of PVP. Currently, low, medium and high viscosity PMMA bone cements are used interchangeably. However, effect of viscosity on clinical outcome in patients with Osteoporotic Vertebral Compression Fractures (OVCFs) has not yet been explicit subject of investigation. PURPOSE: Comparison of outcome between patients treated PVP using low and medium viscosity PMMA bone cement. STUDY DESIGN/SETTING: Comparative, prospective follow-up study. PATIENT SAMPLE: Thirty consecutive patients who received PVP using low viscosity PMMA bone cement (OsteoPal-VÒ) for 62 OVCFs, followed by 34 patients who received PVP using medium viscosity PMMA bone cement (Disc-O-TechÒ) for 67 OVCFs.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.
Proceedings of the NASS 25th Annual Meeting / The Spine Journal 10 (2010) 1S–149S
CONCLUSIONS: Reduction of physiological curvatures in lumbar spine led to the increased risk of vertebral fracture by more than 3 fold. Importance of evaluating sagittal spinal alignment should be emphasized because it might indicate the risk of the first vertebral fracture, which is a strong predictor of subsequent fractures. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.307
P32. Prospective Comparative Analysis of Minimally Invasive Lumbar Posterolateral Fusion with Percutaneous Pedicle Screws vs. Conventional Approach for Degenerative Spondylolisthesis Yoshihisa Kotani, MD, Manabu Ito, MD, PhD, Kuniyoshi Abumi, MD, Hideki Sudo, MD, Shigeki Oshima, MD, Yuichiro Abe, MD, Akio Minami, MD; Dept. of Orthopedic Surgery, Hokkaido University, Sapporo, Japan BACKGROUND CONTEXT: To minimize the perioperative invasiveness and improve the quality of life, we have performed the minimally invasive lumbar posterolateral fusion (MIS-PLF) with percutaneous pedicle screw fixation for degenerative spondylolisthesis. PURPOSE: This study prospectively compared the clinical result of MISPLF with that of conventional PLF (Open-PLF) with emphasis on perioperative invasiveness and patients’ quality of life. STUDY DESIGN/SETTING: Clinical prospective cohort study. PATIENT SAMPLE: The total of eighty patients received single-level PLF for lumbar degenerative spondylolisthesis. There were forty-three cases of MIS-PLF and thirty-seven cases of Open-PLF. OUTCOME MEASURES: Analyzed parameters up to two years period included the operation time, intra and postoperative blood loss, OswestryDisability Index(ODI), Roland-Morris Questionnaire (RMQ), JOA score, and VAS scores of low back pain. The fusion rate and complications were also reviewed. METHODS: The surgical technique of MIS-PLF includes 4 cm of main incision and percutaneous pedicle screwing and rod insertion. The posterolateral gutter including the medial transverse process was decorticated and iliac bone graft was performed. RESULTS: The minimum follow-up period was twelve months postoperatively (Ave. 32 months). The average length of main incision was 4.5 cm in MIS-PLF and 12 cm in open-PLF, respectively. The average operation time was statistically equivalent between two groups. The intraoperative blood loss was significantly smaller in MIS-PLF group (181 cc) when compared to open-PLF group (453 cc). The postoperative bleeding on day 1 was also smaller in MIS-PLF group (210 cc) when compared to open-PLF group (406 cc).The ODI and RMQ score rapidly decreased at initial two weeks postoperatively in MIS-PLF group, and consistently maintained lower values than those in open-PLF group at 3, 6, 12 and 24 months postoperatively. The VAS score demonstrated further rapid decreases on postoperative day 1, 3, and 7 in MIS-PLF group. The fusion rate was statistically equivalent between two groups (98% vs. 100%), and no major complications were demonstrated. CONCLUSIONS: The minimally invasive lumbar posterolateral fusion with percutaneous pedicle screw system successfully decreased the perioperative invasiveness when compared to conventional open-PLF. The reduction of postoperative pain led to early extension of ADL, demonstrating the rapid improvement of several QOL parameters. This superiority in MIS-PLF group was maintained until two-year period, suggesting better long-term effect of less invasive PLF on low back pain and QOL. The MIS-PLF utilizing percutaneous pedicle screw fixation serves as a good alternative approach, obviating the needless interbody fusion in minimally invasive approach. Even in the minimum access surgery, the use of interbody fusion can be avoided with this surgical technique. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.308
P33. Percutaneous Vertebroplasty in Very Severe Osteoporotic Vertebral Compression Fractures: Feasible and Beneficial Marc J. Nieuwenhuijse, MD, Sander P.D. Dijkstra, MD, PhD, Arian R. van Erkel, MD, PhD; Leiden University Medical Center, Leiden, Netherlands BACKGROUND CONTEXT: Patient selection criteria in Percutaneous VertebroPlasty (PVP) should be individually optimized. PVP in patients presenting with collapse of the vertebral body to less than one-third of its original height, termed vsOVCFs, is considered technically demanding and by some a relative contra-indication. Reports explicitly assessing treatment of vsOVCFs are scarce and efficacy and safety of PVP in vsOVCFs is not firmly established. PURPOSE: Establishment of clinical outcome and technical feasibility of PVP in very severe Osteoporotic Vertebral Compression Fractures (vsOVCFs). STUDY DESIGN/SETTING: Prospective (cohort) follow-up study. PATIENT SAMPLE: Thirty-seven vsOVCFs in 34 patients were identified. OUTCOME MEASURES: PI-NRS, SF-36, cement leakage on postoperative CT-scanning, complications. METHODS: Follow-up was conducted using a 0–10 Pain Intensity Numerical Rating Scale (PI-NRS) and the Short Form 36 (SF-36) quality of life questionnaire before PVP and at 7 days (PI-NRS only), 1, 3 and 12 months after PVP. Injected cement volume and cement leakage was analyzed on direct post-operative CT-scanning. At six and 52 weeks and at suspicion, patients were analyzed for new fractures. RESULTS: Thirty-seven vsOVCFs in 34 patients were identified. Decrease in PI-NRS for average and worst back pain was respectively 2.5 and 2.9 points after 7 days and 2.4 and 2.7 points after 12 months. Increase in the SF-36 Physical Component Score was significant and clinically relevant with 2.0 at one moth and 2.6 at one year, whereas the Mental Component Score showed a gradual but eventually significant and clinically relevant increase of 7.5 points. Mean injected cement volume was 3.6 mL. Cement leakage was detected in 91.9% of treated vsOVCFs. No major and one minor complication, being temporal spontaneous focal resorption of the upper adjacent disc and vertebral body after intradiscal cement leakage, occurred. CONCLUSIONS: Patients with painful very severe OVCFs benefit from PVP. Although technically more demanding and with a higher procedural risk, ie, more frequent necessity of placement of a second needle, higher leakage incidence and greater leakage volumes, PVP is technically feasible and should not be withheld from these patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. doi: 10.1016/j.spinee.2010.07.309 P34. A Clinical Comparative Study on Low vs. Medium Viscosity PMMA Bone Cement in Percutaneous Vertebroplasty: Viscosity Associated with Cement Leakage Marc J. Nieuwenhuijse, MD, Sander P.J. Muijs, MD, Arian R. van Erkel, MD, PhD, Sander P.D. Dijkstra, MD, PhD; Leiden University Medical Center, Leiden, Netherlands BACKGROUND CONTEXT: Viscosity is the main characterizing parameter of PolyMethylMetAcrylate (PMMA) bone cement, currently the standard augmentation material in Percutaneous VertebroPlasty (PVP), and influences cement interdigitation and distribution inside the vertebral body as well as injected volume and extravasation, thereby affecting the clinical outcome of PVP. Currently, low, medium and high viscosity PMMA bone cements are used interchangeably. However, effect of viscosity on clinical outcome in patients with Osteoporotic Vertebral Compression Fractures (OVCFs) has not yet been explicit subject of investigation. PURPOSE: Comparison of outcome between patients treated PVP using low and medium viscosity PMMA bone cement. STUDY DESIGN/SETTING: Comparative, prospective follow-up study. PATIENT SAMPLE: Thirty consecutive patients who received PVP using low viscosity PMMA bone cement (OsteoPal-VÒ) for 62 OVCFs, followed by 34 patients who received PVP using medium viscosity PMMA bone cement (Disc-O-TechÒ) for 67 OVCFs.
All referenced figures and tables will be available at the Annual Meeting and will be included with the post-meeting online content.