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

作者：Lee Gun Woo; Yeom Jin S; Kim Ho Joong; Suh Bo Gun^*

来源：Spine, 2013, 38(4): E244-E250.

DOI：10.1097/BRS.0b013e31827efef2

• osteonecrosis
• vertebral body
• bone graft
• posterior instrumentation

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.

• 出版日期2013-2-15