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Vertebral body osteonecrosis: proposal of a treatment-oriented classification system

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Abstract

Purpose

To present a classification system for vertebral body osteonecrosis (VBON) based on imaging findings and sagittal alignment and consequently to propose treatment guidelines.

Methods

Chart review and classification of imaging and clinical findings. An analysis of literature about VBON has been evaluated to conceive the classification. The current data allows to correlate radiological findings with different stages of the pathophysiological process and consequently to propose a patient-tailored treatment plan.

Results

The classification identifies 4 stages: stage 0 (theoretical phase), stage 1 (early phase), stage 2 (instability phase) and stage 3 (fixed deformity phase). Local (angular kyphosis expressed as anterior–posterior wall height ratio) and global (sagittal vertical axis and pelvic tilt) sagittal alignment are considered as complementary modifiers to tailor the most suitable treatment. Stage 1 is generally managed conservatively. Stage 2 and 3 often require different surgical approaches according to local and global sagittal alignment.

Conclusions

The classification allows a systematic staging of this disease and can help establish a proper and patient-oriented treatment plan. Further researches are advocated to fully validate the proposed classification system.

Graphical abstract

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Authors and Affiliations

  1. Clinica Ortopedica – Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, GE, Italy

    Matteo Formica, Andrea Zanirato, Luca Cavagnaro, Marco Basso, Stefano Divano & Lamberto Felli

  2. Gspine4 - IRCCS Istituto Ortopedico Galeazzi, Via R. Galeazzi 4, 20161, Milan, MI, Italy

    Claudio Lamartina, Pedro Berjano & Carlo Formica

Authors
  1. Matteo Formica
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  2. Andrea Zanirato
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  3. Luca Cavagnaro
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  4. Marco Basso
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  5. Stefano Divano
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  6. Claudio Lamartina
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  7. Pedro Berjano
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  8. Lamberto Felli
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  9. Carlo Formica
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Corresponding author

Correspondence to Matteo Formica.

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Conflict of interest

Pedro Berjano received honorarium for surgeons’ education activities from Nuvasive, Medacta, DepuySynthes and his department received unrestricted research grants from Nuvasive, Medacta, DepuySynthes and K2 M. Claudio Lamartina received honorarium for surgeons’ education activities from Nuvasive, Medacta, DepuySynthes and K2 M and his department received unrestricted research grants from Nuvasive, Medacta, DepuySynthes and K2 M. No other disclosures by the rest of authors.

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Formica, M., Zanirato, A., Cavagnaro, L. et al. Vertebral body osteonecrosis: proposal of a treatment-oriented classification system. Eur Spine J 27 (Suppl 2), 190–197 (2018). https://doi.org/10.1007/s00586-018-5600-6

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  • DOI: https://doi.org/10.1007/s00586-018-5600-6

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