Chiu Yen-Chun, Yang Shih-Chieh, Chen Hung-Shu, Kao Yu-Hsien, Tu Yuan-Kun
Department of Orthopedic Surgery and Anesthesiology, E-Da Hospital/I-Shou University, 1, E-Da Road, Kaohsiung City, Taiwan.
J Orthop Surg Res. 2015 Feb 10;10:28. doi: 10.1186/s13018-015-0169-9.
Complications and failure of vertebroplasty, such as cement dislodgement, cement leakage, or spinal infection, usually result in spinal instability and neural element compression. Combined anterior and posterior approaches are the most common salvage procedure for symptomatic failed vertebroplasty. The purpose of this study is to evaluate the feasibility and efficacy of a single posterior approach technique for the treatment of patients with symptomatic failed vertebroplasty.
Ten patients with symptomatic failed vertebroplasty underwent circumferential debridement and anterior reconstruction surgery through a single-stage posterior transpedicular approach (PTA) from January 2009 to December 2011 at our institution. The differences of visual analog scale (VAS), neurologic status, and vertebral body reconstruction before and after surgery were recorded. The clinical outcomes of patients were categorized as excellent, good, fair, or poor based on modified Brodsky's criteria.
The symptomatic failed vertebroplasty occurred between the T11 and L3 vertebrae with one- or two-level involvement. The average VAS score was 8.3 (range, 7 to 9) before surgery, significantly decreased to 3.2 (range, 2 to 4) after surgery (p < 0.01), and continued to decrease to 2.4 (range, 2 to 3) 1 year later (p < 0.01). The average correction of Cobb's angle after surgery was 17.3° (range, 4° to 35°) (p < 0.01). The mean loss of Cobb's angle correction after 1 year of follow-up was 2.7° (range, 0° to 5°). The average allograft subsidence at 1 year after surgery was 1 mm (range, 0 to 2). The neurologic status of Frankel's scale significantly improved after surgery (p = 0.014) and at 1 year after surgery (p = 0.046). No one experienced severe complications such as deep wound infection or neurologic deterioration. All patients achieved good or excellent outcomes after surgery based on modified Brodsky's criteria (p < 0.01).
Single-stage PTA surgery with circumferential debridement and anterior reconstruction technique provides good clinical outcomes and low complication rate, which can be considered as an alternative method to combined anterior and posterior approaches for patients with symptomatic failed vertebroplasty.
椎体成形术的并发症及失败，如骨水泥移位、骨水泥渗漏或脊柱感染，通常会导致脊柱不稳定和神经受压。前后联合入路是症状性椎体成形术失败后最常用的挽救手术。本研究的目的是评估单后路技术治疗症状性椎体成形术失败患者的可行性和疗效。
2009年1月至2011年12月，我院10例症状性椎体成形术失败患者通过单阶段后路经椎弓根入路（PTA）接受了环形清创和前路重建手术。记录手术前后视觉模拟量表（VAS）、神经功能状态和椎体重建的差异。根据改良的布罗茨基标准，将患者的临床结果分为优、良、中、差。
症状性椎体成形术失败发生在T11和L3椎体之间，累及1或2个节段。术前平均VAS评分为8.3（范围7至9），术后显著降至3.2（范围2至4）（p < 0.01），1年后继续降至2.4（范围2至3）（p < 0.01）。术后Cobb角平均矫正17.3°（范围4°至35°）（p < 0.01）。随访1年后Cobb角矫正丢失平均为2.7°（范围0°至5°）。术后1年同种异体骨平均下沉1mm（范围0至2）。Frankel分级的神经功能状态术后（p = 0.014）及术后1年（p = 0.046）显著改善。无人发生深部伤口感染或神经功能恶化等严重并发症。根据改良的布罗茨基标准，所有患者术后均获得良好或优秀的结果（p < 0.01）。
单阶段PTA手术联合环形清创和前路重建技术临床效果良好，并发症发生率低，可作为症状性椎体成形术失败患者前后联合入路的替代方法。
