Medical Student Loma Linda University School of Medicine Loma Linda, CA, US
Introduction: Advancements in correcting kyphotic deformity have attempted to mitigate vertebral fractures and cement leakage of osteoporotic patients. However, osteoporotic patients continue to have high rates of postoperative complications and face significant risks such as subsequent fractures and spacers telescoping into vertebral bodies. This study proposes a novel anterior cement augmentation technique for correction of kyphotic deformity involving an oblique lateral interbody fusion approach.
Methods: Patient 1 underwent a stage-one procedure including anterior lateral L3 corpectomy via an oblique lateral interbody fusion approach. Cement was placed anterolaterally at L2 and L4 and an expandable cage was placed. A stage-two procedure was performed two days following stage one. A posterior T12-to-pelvis instrumented fusion was performed with prophylactic cement augmentation at T11, followed by T12, L1, and L2 vertebral body augmentation. Pontine osteotomy and compression were performed and applied between L2-L4. Patient 2 underwent an anterior C4-T2 and posterior C4-S1 osteotomy and instrumented fusion. The patient developed immediate postoperative instrumentation failure with kyphosis at L4-L5 and instrumentation loosening and migration from L4-S1 within 2 weeks of surgery. The patient then underwent oblique lateral interbody fusion at L4-L5 with anterior cement augmentation, followed by a revision lumbar-pelvis instrumentation.
Results: Both patients demonstrated significant kyphotic deformity correction with 2 year follow-up records suggesting favorable outcomes.
Conclusion : Our anterior cement augmentation technique presents a novel alternative for correction of kyphotic deformity and restoration of sagittal alignment in the lumbar spine of osteoporotic patients. Using a minimally invasive, anterior-to-psoas approach may decrease morbidity of approach related complications.
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