Mehta Gaurav, Patel Ankit, Jain Sanyam, Merchant Zahir Abbas, Kundnani Vishal
Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India.
Asian J Neurosurg. 2019 Nov 25;14(4):1207-1213. doi: 10.4103/ajns.AJNS_95_19. eCollection 2019 Oct-Dec.
The aim of this study is to evaluate clinico-radiological outcomes of posterior surgery (decompression + instrumentation + transpedicular bone graft) in osteoporotic burst fracture associated with neurological deficit [OFND].
Forty patients with neurological deficit due to delayed osteoporotic vertebral collapse managed by posterior surgery (decompression + instrumentation + transpedicular bone graft) with minimum 2 years follow-up were included in the study. Approval from the Institutional Review Board was taken. Demographic data (age, sex, mode of injury, and the severity of osteoporosis); clinical parameters (Visual Analog Score [VAS], Oswestry Disability Index [ODI], Frankel grade), radiological parameters (local kyphosis), and surgical variables (blood loss, surgery duration, and intraoperative events) were recorded. Neurological worsening/improvement, complications, and implant failures were noted.
Significant improvement was noted in VAS (preoperative 8.20 ± 0.65/postoperative 4.1 ± 0.64) and ODI (preoperative 76.54 ± 6.96/postoperative 30.5 ± 6.56). Complete neurological recovery was noted in 37 patients (Frankel Grade E), three patients remained nonambulatory (Frankel Grade C). Significant improvement was noted in local kyphosis angle (preoperative = 21.80 ± 2.70; postoperative 11.40 ± 1.80), with 10% loss of correction (2.5 ± 0.90) at final follow-up. Symptomatic implant failure was noted in two patients and proximal junctional failure in one patient requiring an extension of fixation.
OFND can be managed with a single posterior-only surgery with significant improvement in neurology and functional scores of patients. Aggressive kyphosis correction is often not required and optimal correction of kyphosis is noticed due to prone-positioning alone. Transpedicular grafting is safe and simple alternative to cement augmentation or anterior surgery for collapsed vertebrae.
本研究旨在评估后路手术（减压+内固定+经椎弓根植骨）治疗伴有神经功能缺损的骨质疏松性爆裂骨折[OFND]的临床和放射学结局。
本研究纳入40例因骨质疏松性椎体延迟塌陷导致神经功能缺损且接受后路手术（减压+内固定+经椎弓根植骨）并至少随访2年的患者。获得了机构审查委员会的批准。记录人口统计学数据（年龄、性别、损伤方式和骨质疏松严重程度）；临床参数（视觉模拟评分[VAS]、Oswestry功能障碍指数[ODI]、Frankel分级）、放射学参数（局部后凸）和手术变量（失血量、手术时间和术中情况）。记录神经功能恶化/改善情况、并发症和内植物失败情况。
VAS（术前8.20±0.65/术后4.1±0.64）和ODI（术前76.54±6.96/术后30.5±6.56）有显著改善。37例患者实现了神经功能完全恢复（Frankel E级），3例患者仍无法行走（Frankel C级）。局部后凸角有显著改善（术前=21.80±2.70；术后11.40±1.80），末次随访时矫正丢失10%（2.5±0.90）。2例患者出现有症状的内植物失败，1例患者出现近端交界性失败需要延长固定。
OFND可通过单一后路手术治疗，患者的神经功能和功能评分有显著改善。通常不需要积极的后凸矫正，仅因俯卧位即可实现最佳的后凸矫正。经椎弓根植骨是椎体塌陷的骨水泥强化或前路手术的安全、简单替代方法。
