Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy
Abstract Background Lower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). Surgical intervention requires posterior instrumented lumbar fusion as well as vertebral augmentation...
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| Format: | Article |
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BMC
2021-06-01
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| Series: | Journal of Orthopaedic Surgery and Research |
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| Online Access: | https://doi.org/10.1186/s13018-021-02532-0 |
| _version_ | 1798043391046451200 |
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| author | Min-Seok Kang Dong-Hwa Heo Hoon-Jae Chung Ki-Han You Hyong-Nyun Kim Jun-Young Choi Hyun-Jin Park |
| author_facet | Min-Seok Kang Dong-Hwa Heo Hoon-Jae Chung Ki-Han You Hyong-Nyun Kim Jun-Young Choi Hyun-Jin Park |
| author_sort | Min-Seok Kang |
| collection | DOAJ |
| description | Abstract Background Lower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). Surgical intervention requires posterior instrumented lumbar fusion as well as vertebral augmentation or anterior column reconstruction depending on the cleft formation and intravertebral instability. However, it is necessary to decide on surgery in consideration of the patient’s frail status, surgical invasiveness, and rehabilitation. In the lower lumbar DVC without intravertebral instability, biportal endoscopic posterior lumbar decompression and vertebroplasty (BEPLD + VP) can be simultaneously attempted. This study aimed to assess the clinical outcomes of BEPLD + VP for the treatment of DVC-related LSR. Methods This retrospective case series enrolled 18 consecutive extremely elderly (aged ≥ 75-year-old) patients (6 men and 12 women) who had lower lumbar (at or below L3) DVC-related LSR. Patients who require anterior column reconstruction, such as cleft formation accompanied by intravertebral instability and patients who have not been followed for more than 6 months, were excluded from this study. All patients underwent BEPLD + VP under epidural anesthesia. Clinical results were evaluated by the visual analog scale (VAS) score and the modified Japanese Orthopedic Association (mJOA) scores. Results Most of the patients had DVC affecting level L4, with the deformation being a flat type or concave type rather than a wedge type. The VAS score (back and leg) significantly decreased from 7.78 ± 1.17 and 6.89 ± 1.13 preoperatively to 2.94 ± 0.64 and 2.67 ± 1.08 within 2 postoperative days (p < 0.001). The mJOA score significantly improved from 4.72 ± 1.27 preoperatively to 8.17 ± 1.15 in the final follow-up (p < 0.001). The mean recovery rate (RR) in the last follow-up was 56.07% ± 9.98. Incidental durotomy was reported in two patients and epidural hematomas in another two patients; however, all patients improved with conservative treatment, and no re-operation was required. Conclusions BELPD + VP was a type of salvage therapy that reduces surgical morbidity, requires major spine surgery under general anesthesia and provides good clinical outcomes in extremely elderly patients with DVC-related LSR. |
| first_indexed | 2024-04-11T22:48:24Z |
| format | Article |
| id | doaj.art-c93f30a453134f4d968a9fb7f886e050 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-11T22:48:24Z |
| publishDate | 2021-06-01 |
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| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-c93f30a453134f4d968a9fb7f886e0502022-12-22T03:58:41ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2021-06-011611810.1186/s13018-021-02532-0Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathyMin-Seok Kang0Dong-Hwa Heo1Hoon-Jae Chung2Ki-Han You3Hyong-Nyun Kim4Jun-Young Choi5Hyun-Jin Park6Department of Orthopedic Surgery, Bumin HospitalDepartment of Neurosurgery, Bumin HospitalDepartment of Orthopedic Surgery, Bumin HospitalDepartment of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of MedicineDepartment of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of MedicineDepartment of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of MedicineDepartment of Orthopedic Surgery, Spine Center, Kangnam Sacred Heart Hospital, Hallym University College of MedicineAbstract Background Lower lumbar osteoporotic vertebral compression fracture in extremely elderly patients can often lead to lumbosacral radiculopathy (LSR) due to delayed vertebral collapse (DVC). Surgical intervention requires posterior instrumented lumbar fusion as well as vertebral augmentation or anterior column reconstruction depending on the cleft formation and intravertebral instability. However, it is necessary to decide on surgery in consideration of the patient’s frail status, surgical invasiveness, and rehabilitation. In the lower lumbar DVC without intravertebral instability, biportal endoscopic posterior lumbar decompression and vertebroplasty (BEPLD + VP) can be simultaneously attempted. This study aimed to assess the clinical outcomes of BEPLD + VP for the treatment of DVC-related LSR. Methods This retrospective case series enrolled 18 consecutive extremely elderly (aged ≥ 75-year-old) patients (6 men and 12 women) who had lower lumbar (at or below L3) DVC-related LSR. Patients who require anterior column reconstruction, such as cleft formation accompanied by intravertebral instability and patients who have not been followed for more than 6 months, were excluded from this study. All patients underwent BEPLD + VP under epidural anesthesia. Clinical results were evaluated by the visual analog scale (VAS) score and the modified Japanese Orthopedic Association (mJOA) scores. Results Most of the patients had DVC affecting level L4, with the deformation being a flat type or concave type rather than a wedge type. The VAS score (back and leg) significantly decreased from 7.78 ± 1.17 and 6.89 ± 1.13 preoperatively to 2.94 ± 0.64 and 2.67 ± 1.08 within 2 postoperative days (p < 0.001). The mJOA score significantly improved from 4.72 ± 1.27 preoperatively to 8.17 ± 1.15 in the final follow-up (p < 0.001). The mean recovery rate (RR) in the last follow-up was 56.07% ± 9.98. Incidental durotomy was reported in two patients and epidural hematomas in another two patients; however, all patients improved with conservative treatment, and no re-operation was required. Conclusions BELPD + VP was a type of salvage therapy that reduces surgical morbidity, requires major spine surgery under general anesthesia and provides good clinical outcomes in extremely elderly patients with DVC-related LSR.https://doi.org/10.1186/s13018-021-02532-0Delayed vertebral collapseOsteoporotic vertebral compression fractureLumbosacral radiculopathyExtremely elderly patientsBiportal endoscopic posterior lumbar decompressionVertebroplasty |
| spellingShingle | Min-Seok Kang Dong-Hwa Heo Hoon-Jae Chung Ki-Han You Hyong-Nyun Kim Jun-Young Choi Hyun-Jin Park Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy Journal of Orthopaedic Surgery and Research Delayed vertebral collapse Osteoporotic vertebral compression fracture Lumbosacral radiculopathy Extremely elderly patients Biportal endoscopic posterior lumbar decompression Vertebroplasty |
| title | Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy |
| title_full | Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy |
| title_fullStr | Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy |
| title_full_unstemmed | Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy |
| title_short | Biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy |
| title_sort | biportal endoscopic posterior lumbar decompression and vertebroplasty for extremely elderly patients affected by lower lumbar delayed vertebral collapse with lumbosacral radiculopathy |
| topic | Delayed vertebral collapse Osteoporotic vertebral compression fracture Lumbosacral radiculopathy Extremely elderly patients Biportal endoscopic posterior lumbar decompression Vertebroplasty |
| url | https://doi.org/10.1186/s13018-021-02532-0 |
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