Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty in the surgical treatment of thoracolumbar osteoporosis fracture

Clinical article

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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.

Abbreviations used in this paper:PKP = percutaneous kyphoplasty; PVP = percutaneous vertebroplasty; VAS = visual analog scale; VB = vertebral body; VCF = vertebral compression fracture.

Article Information

Address correspondence to: Yutong Gu, M.D., Ph.D., Department of Orthopaedics, Zhongshan Hospital of Fudan University, Shanghai 200032, China. email: tonygu633@hotmail.com.

Please include this information when citing this paper: published online April 5, 2013; DOI: 10.3171/2013.3.SPINE12827.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Left: Photograph showing placement of a pedicle screw into the vertebra adjacent to the fractured one by using a minimally invasive technique. Right: Fluoroscopic image showing injection of cement after minimally invasive pedicle screw-and-rod reduction and fixation.

  • View in gallery

    Axial CT scans obtained immediately after reconstruction, for verification of pedicle screw positioning and to search for cement leakage.

  • View in gallery

    Preoperative lateral view of the fracture (A), postoperative lateral view (B), and evolution at 2-year follow-up (C) showing no significant loss of correction in the same patient.

  • View in gallery

    Minimally invasive access. Photograph showing cosmetic results obtained after the insertion of pedicle screws and vertebroplasty (Day 7 after surgery).

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