- Background: Vertebral body replacements (VBRs) with expandable cages with larger endplates allow more distraction due to their larger footprints. Aim of this study was to analyze the rate of segmental correction and subsidence rates in patients with osteoporotic and pathological fractures.
Methods: A retrospective analysis from February 2015 until July 2019 of patients following a staged posterior pedicle screw instrumentation and VBR with expandable cages with large endplates (Samson ®, HumanTech) was performed. Plain radiographs and CT- imaging were performed before and after the surgery and at last follow up. Radiological data such as local sagittal angle and segmental height as well as revision rates were analyzed.
Results: A cohort of 58 consecutive patients were identified. 62% were female and the median age was 68 years. Median follow up was 8 months. There were 22, 20, and 16 cases of osteoporotic fractures, spondylodiscitis and 16 metastases respectively. VBR were performedBackground: Vertebral body replacements (VBRs) with expandable cages with larger endplates allow more distraction due to their larger footprints. Aim of this study was to analyze the rate of segmental correction and subsidence rates in patients with osteoporotic and pathological fractures.
Methods: A retrospective analysis from February 2015 until July 2019 of patients following a staged posterior pedicle screw instrumentation and VBR with expandable cages with large endplates (Samson ®, HumanTech) was performed. Plain radiographs and CT- imaging were performed before and after the surgery and at last follow up. Radiological data such as local sagittal angle and segmental height as well as revision rates were analyzed.
Results: A cohort of 58 consecutive patients were identified. 62% were female and the median age was 68 years. Median follow up was 8 months. There were 22, 20, and 16 cases of osteoporotic fractures, spondylodiscitis and 16 metastases respectively. VBR were performed in 31 and 27 in the thoracic and lumbar spine, respectively. There was a significant gain in segmental height of 8 and 11 mm in the thoracic and lumbar spine, respectively. There was a significant segmental angle correction 4° and 6° degrees in the lumbar and thoracic spine, respectively (p=0.000). These significant differences remained throughout follow up (p=0.001). In spondylodiscitis cases, cage over-distraction (mean 6 mm) was associated with higher subsidence rates (mean 8mm, p=0.013) on follow up examinations, which resulted in revision surgery in 3 cases (5%).
Conclusion: Expandable vertebral body replacements with larger endplates achieve satisfactory correction of sagittal height and angle. However over-distraction, especially in infectious cases, is associated with higher subsidence rate.…
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