BACKGROUND: Multiple percutaneous vertebral cement augmentation may create sandwich vertebrae. Whether the sandwich vertebra is at higher risk of further fracture remains unknown. OBJECTIVE: To compare the incidence of further fractures of sandwich vertebrae and adjacent vertebrae and to identify potential risk factors for sandwich vertebral fractures. METHODS: Patients who underwent cement augmentation for osteoporotic vertebral compression fractures (OVCFs) in a single medical center between January 2012 and December 2015 were included. A sandwich vertebra was defined as an intact vertebra located between 2 previously cemented vertebrae. Demographic data and imaging findings were recorded. All patients were followed up for at least 24 mo postoperatively. During follow-up period, if the patient reported new-onset back pain with corresponding imaging findings, a diagnosis of sandwich vertebral fracture was made. RESULTS: Among the 1347 patients who underwent vertebroplasty/kyphoplasty for OVCFs, 127 patients with 128 fracture levels met the criteria for sandwich vertebrae (females/males 100/27, mean age 77.8 ± 7.7 yr old). The fracture location was most common in the thoraco-lumbar junction (T10-L2), 68.5% (87/127). The incidence of sandwich vertebral fracture was 21.3%, whereas the incidence of adjacent level fracture of those with no sandwich vertebra was 16.4% (196/1194), P = .1879. CONCLUSION: The incidence of sandwich vertebral fracture is not higher than that at the adjacent levels. The factor associated with further sandwich vertebral fracture was male gender. Once sandwich vertebral fracture occurred, patients may seek more surgical intervention than those with only adjacent fractures.

In Taiwan, the life expectancy of an 80-year-old man is 88.4 years and the life expectancy of an 80-year-old woman is 89.8 years. Some of these people will develop symptomatic degenerative lumbar diseases that interfere with an active lifestyle. These older surgical candidates usually ask the surgeon whether it would be safe to undergo surgery. However, there is no literature assessing the outcomes of laminectomy, fusion and posterior fixation for degenerative lumbar diseases in patients older than 80 years. The purpose of this study was to report the surgical outcomes of patients 80 years of age and older who underwent spinal decompression and instrumented lumbar arthrodesis for degeneration lumbar diseases. We retrospectively reviewed patients with degenerative lumbar diseases and spinal stenosis who underwent surgery between January 2010 and December 2012. Inclusion criteria were age greater than or equal to 80 years, decompression with instrumented lumbar arthrodesis, and at least 2 years of follow-up. Totally 89 patients were studies. Clinical outcomes were evaluated according to the Oswestry Disability Index (ODI) and visual analogue scale (VAS) of leg and back pain. Plain radiographs (lateral, anteroposterior, and flexion-extension) were used to assess the status of fusion and implant-related complications. Every complication during admission and any implant-related or failed-back syndrome requiring a second surgery was documented. T test and Fisher’s exact test were used for statistical analysis. Five patients were lost to follow-up, and another 12 died during the follow-up period. One patient died due to cerebral stroke just 2 days after surgery, and the other 11 patients passed away 3 months to 4 years postoperatively. In all, 72 patients had an adequate follow-up: 44 were female and 28 were male. The average age at surgery was 82.5 ± 2.6 years (80 to 93); 63 patients underwent their first lumbar surgery, and nine patients received a second surgery. Patients underwent arthrodesis surgeries were from a single-level to a 7–level. Four patients developed complications (5.6 %, 4/72). At the final follow-up, the average ODI score was lower than the preoperative score (30.0 vs. 61.8) (p < 0.001). The average VAS score also showed improvement (leg: p < 0.001; back: p < 0.001). Forty-three patients were classified as “satisfied”, and 29 were “dissatisfied”. Longer operation time (p = 0.014) and development of complications (p = 0.049) were related to poor clinical results. Radiographic follow-up showed that 53 patients had solid union, ten had a probable union, and nine had pseudarthrosis. More surgical segments led to a greater chance of pseudarthrosis (2.0 ± 0.9 vs 3.0 ± 1.8, p = 0.003). Longer instrumented segments and development of complications contributed to worse clinical and radiographic outcomes. With proper patient selection, posterior decompression with instrumented fusion can be safe and effective for patients 80 years of age and older with degenerative lumbar conditions.

The aim of our study was to investigate the association between global spinal alignment, spinopelvic parameters, and outcomes of osteoporotic vertebral compression fractures (OVCF). Patients with vertebral compression fractures seen at our hospital between October 2017 and November of 2018 with a bone mineral density (BMD) T-score < −2.5 were recruited for the study. Surgical intervention was performed after eight weeks of conservative treatment depending on clinical symptoms and the willingness of patients. Spinopelvic and sagittal alignment parameters were compared between patients who had surgery and those that did not. Seventy-nine patients were included in the study. Twenty-five patients (31.6%, mean age: 73.28 ± 9.78 years) received surgery, and 54 (68.3%, mean age: 73 ± 8.58 years) conservative treatment only. Pelvic tilt, pelvic incidence, and local kyphotic angle were statistically different between the groups (all p < 0.05). A sagittal vertical axis ≥ 50 mm, distance between the C7 plumb line and the center of the fractured vertebra (DSVA) ≥ 60 mm, pelvic incidence outside of the range of 44 to 62°), and pelvic tilt ≥ 27° were associted with the need for surgical intervention. Measurement of spinopelvic parameters can predict the need for surgery in patients with OVCF.