Schwarz Falko, Burckhart Michaela, McLean Aaron Lawson, Kalff Rolf, Waschke Albrecht
Department for Neurosurgery, Jena University Hospital - Friedrich Schiller University Jena, Germany.
Int J Spine Surg. 2018 Oct 15;12(5):565-570. doi: 10.14444/5069. eCollection 2018 Oct.
The aim of our study was to identify factors that influence the occurrence of adjacent fractures in patients with cement-augmented pedicle screw instrumentation.
Data were retrospectively collected from medical charts and operative reports for every surgery in which cement-augmented instrumentation was used in our hospital of 4 consecutive years. A total of 93 operations were included and examined for gender, age, T-score, number of fused segments, number of implanted screws, broken screws, loosening of screws, leakage and distribution pattern of cement, pre- and postoperative kyphosis angle, revision surgery and adjacent fractures in follow-up. Categorical data were compared using the χ test or by Fisher's exact test, as appropriate. Continuous variables conforming to a normal distribution were compared using Student's test. Otherwise the Mann-Whitney test was applied. A -value of <.05 was considered statistically significant. A trend was defined as a < .2.
The mean age was 68.1 years with a mean T-score of -3.12. Nineteen adjacent fractures occurred during follow-up and the median follow-up was 12 months (range, 1-27). Patients showed a higher risk for adjacent fractures following revision surgery ( = .016). Most fractures occurred superior to the instrumented level ( = .013) and in the first 12 months. Difference of T-score between the group "no adjacent fracture" and the group "adjacent fracture" was 0.7 ( = .138). Another trends were found in greater age ( = .119) and long instrumentations ( = .199).
Revision surgeries are associated with a higher risk of adjacent fractures. In these cases, prophylactic kyphoplasty of the superior vertebra should be considered. This study is a retrospective, nonrandomized cohort/follow-up study.
我们研究的目的是确定影响骨水泥增强椎弓根螺钉内固定患者相邻节段骨折发生的因素。
回顾性收集我院连续4年使用骨水泥增强内固定的每例手术的病历和手术报告数据。共纳入93例手术，检查患者的性别、年龄、T值、融合节段数、植入螺钉数、螺钉断裂、螺钉松动、骨水泥渗漏及分布模式、术前和术后后凸角、翻修手术及随访期间的相邻节段骨折情况。分类数据采用χ检验或Fisher精确检验进行比较（视情况而定）。符合正态分布的连续变量采用Student's检验进行比较。否则应用Mann-Whitney检验。P值<0.05被认为具有统计学意义。趋势定义为P<0.2。
平均年龄为68.1岁，平均T值为-3.12。随访期间发生19例相邻节段骨折，中位随访时间为12个月（范围1-27个月）。翻修手术后患者发生相邻节段骨折的风险更高（P=0.016）。大多数骨折发生在器械固定节段上方（P=0.013）且在最初12个月内。“无相邻节段骨折”组与“相邻节段骨折”组的T值差异为0.7（P=0.138）。在年龄较大（P=0.119）和内固定节段较长（P=0.199）方面发现了其他趋势。
翻修手术与相邻节段骨折的较高风险相关。在这些情况下，应考虑对上位椎体进行预防性后凸成形术。本研究为回顾性、非随机队列/随访研究。
3级。
