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  • Author or Editor: Xiaoxing Jiang x
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Yutong Gu, Feng Zhang, Xiaoxing Jiang, Lianshun Jia and Robert McGuire

Object

The purpose of this study was to evaluate the feasibility and safety of minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty (PVP) for treating acute thoracolumbar osteoporotic vertebral compression fracture (VCF) and preventing secondary VCF after PVP.

Methods

Twenty patients with a mean age of 73.6 years (range 65–85 years) who sustained fresh thoracic or lumbar osteoporotic VCFs without neurological deficits underwent minimally invasive pedicle screw fixation combined with PVP. Visual analog scale pain scores were recorded, and the Cobb angles and the central and anterior vertebral body (VB) heights were measured on the lateral radiographs before surgery and immediately, 1 month, 2 months, 3 months, 6 months, 1 year, and 2 years after surgery.

Results

The patients were followed up for an average of 26 months (range 24–30 months) after sugery. The visual analog scale score was found to be significantly decreased; from 7.3 ± 1.3 before surgery to 1.2 ± 0.7 immediately after surgery and to 0.7 ± 0.7 (p < 0.001) at the end of follow-up. The Cobb angle was 17.0° ± 4.3° before surgery and 6.4° ± 3.6° immediately after surgery. The central VB height that was 44.5% ± 7.6% before surgery increased to 74.6% ± 6.4% of the estimated intact central height immediately after surgery (p < 0.001). The anterior VB height increased from 50.7% ± 7.4% before surgery to 82.5% ± 6.7% of the estimated intact anterior height immediately after surgery (p < 0.001). There were no significant changes in the results obtained over the follow-up time period. There was no occurrence of new fracture in surgically treated or adjacent vertebrae in these patients.

Conclusions

Minimally invasive pedicle screw fixation combined with PVP is a good choice for the treatment of acute thoracolumbar osteoporotic VCF and can prevent the occurrence of new VCFs after PVP.

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Fubing Liu, Zhenzhou Feng, Tianze Liu, Qinming Fei, Chun Jiang, Yuanchao Li, Xiaoxing Jiang and Jian Dong

OBJECT

This study sought to make a biomechanical comparison of 3 different posterior fixation techniques for 2-level lumbar spinal disorders.

METHODS

Eight fresh-frozen human cadaver lumbar spines (4 from L-1 to L-5, 4 from L-1 to S-1) were tested by applying pure moments of ± 8 Nm. Each specimen was first tested intact, and then the left facetectomies of L3–4 and L4–5 were performed to establish an unstable condition without removal of discs. Three instrumentation systems were then tested randomly: unilateral pedicle screw (UPS), UPS with contralateral translaminar facet screw (UPSFS), and bilateral pedicle screw (BPS). The range of motion (ROM) and the neutral zone (NZ) of L3–5 were measured.

RESULTS

All fixation types could reduce the ROM of L3–5 significantly in flexion, extension, and lateral bending, compared with the intact state. In axial torsion, only BPS reduced the ROM significantly, compared with the intact state. The UPSFS technique provided intermediate stability, which was superior to the UPS in flexion-extension and lateral bending, and inferior to the BPS in lateral bending. Compared with the intact state, the NZs decreased significantly for UPS, UPSFS, and BPS in flexion-extension, while not significantly in lateral bending and axial torsion.

CONCLUSIONS

In this study, among the 3 fixation techniques, BPS offered the highest stability, UPSFS provided intermediate stability, and UPS was the least stable for 2-level lumbar spinal disorders. UPSFS appeared to be able to offer a less invasive choice than BPS in well-selected patients with 2-level lumbar spinal disorders.