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A Therapeutic Efficacy of the Transpedicular Intracorporeal Bone Graft With Short-Segmental Posterior Instrumentation in Osteonecrosis of Vertebral Body: A Minimum 5-Year Follow-up Study

Lee, Gun Woo MD*; Yeom, Jin S. MD*; Kim, Ho-Joong MD*; Suh, Bo-Gun MD

doi: 10.1097/BRS.0b013e31827efef2
Surgery

Study Design. A retrospective review of clinical and radiological parameters.

Objective. The purpose of this study was to investigate the therapeutic efficacy of transpedicular intracorporeal bone graft (IBG) in osteonecrosis of vertebral body (ONV) for 5-years follow-up period.

Summary of Background Data. Although a broad spectrum of surgical options has been described for the treatment of ONV without neurological deficits, no effective treatment has been definitely established. Limited previous work has reported favorable outcomes with IBG; however, these studies were limited by short-term follow-up and small sample sizes. This study is the first to report the clinical and radiological results of IBG with short-segmental posterior instrumentation in ONV with a 5-year follow-up period.

Methods. Thirty-six patients were followed for at least 5 years after transpedicular IBG with short-segmental posterior instrumentation. We retrospectively reviewed outcomes, including visual analogue scale score, the Oswestry Disability Index score, compression ratio, and kyphotic angle.

Results. There were 11 complications, including pneumonia in 4 patients, screw loosening in 5 patients, mild hematoma at the subcutaneous tissue in 1 case, and pseudarthrosis in 1 case. The mean visual analogue scale score was exhibiting V-shaped upward trend after postoperative 6 months that ended with the almost similar score obtained with preoperative status. The mean Oswestry Disability Index score was also shown with similar trend. In functional score, there was a statistical significant improvement until only 6 months after surgery. In radiological evaluation, the mean kyphotic angle and compression ratio was significantly corrected after surgery (P < 0.05). However, these improved radiological parameters were maximal at the immediate postoperative time with gradual loss over time.

Conclusion. Transpedicular IBG with short-segmental posterior instrumentation may lead to complications such as prolonged back pain and recurrence of kyphotic deformity in the 5 years after the procedure. Therefore, we do not recommend short-segmental posterior instrumentation concurrently with transpedicular IBG for treating ONV.

Level of Evidence: 4

We report that transpedicular intracorporeal bone graft with short-segmental posterior instrumentation may not effectively provide stability or relief of back pain or maintain stabilization for a 5-year follow-up period. We do not recommend this procedure for treating osteonecrosis of vertebral body.

*Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Bundang-gu, Sungnam, Republic of Korea; and

Department of Orthopaedic Surgery, Pohang Semyeng Christianity Hospital, Pohang, Kyeongbuk, Republic of Korea

Address correspondence and reprint requests to Bo-Gun Suh, MD, Department of Orthopaedic Surgery, Pohang Semyeng Christianity Hospital, Daedo Dong 94-5, Nam Gu, Pohang, Kyeongbuk, Republic of Korea; E-mail: spinegwl@gmail.com

Acknowledgment date: July 25, 2012. First revision date: October 14, 2012. Second revision date: November 15, 2012. Acceptance date: November 17, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.