Department of Neurosurgery, China Medical University Hospital, Taichung 404, Taiwan.
China Medical University, Taichung 404, Taiwan.
Medicina (Kaunas). 2020 Feb 17;56(2):82. doi: 10.3390/medicina56020082.
Osteoporotic spinal fractures commonly occur in elderly patients with low bone mineral density. In these cases, percutaneous vertebroplasty or percutaneous kyphoplasty can provide significant pain relief and improve mobility. However, studies have reported both the recurrence of vertebral compression fractures at the index level after vertebroplasty and the development of new vertebral fractures at the adjacent level that occur without any additional trauma. Pedicle screw fixation combined with percutaneous vertebroplasty has been proposed as an effective procedure for addressing osteoporotic thoracolumbar fractures. However, in osteoporotic populations, pedicle screws can loosen, pullout, or migrate. Currently, the efficacy of cortical bone trajectory screw fixation for osteoporotic fractures remains unclear. Thus, we assessed the effects of using cortical bone trajectory instrumentation with vertebroplasty on patient outcomes.
We retrospectively reviewed data from 12 consecutively sampled osteoporotic thoracolumbar fracture patients who underwent cortical bone trajectory instrumentation with vertebroplasty. Patients were enrolled beginning in October 2015 and were followed for >24 months.
The average age was 74 years, and the average dual-energy x-ray absorptiometry T-score was -3.6. The average visual analog scale pain scores improved from 8 to 2.5 after surgery. The average blood loss was 36.25 mL. All patients regained ambulation and experienced reduced pain post-surgery. No recurrent fractures or instrument failures were recorded during follow-up.
Our findings suggest that cortical bone trajectory instrumentation combined with percutaneous vertebroplasty may be a good option for treating osteoporotic thoracolumbar fractures, as it can prevent recurrent vertebral fractures or related kyphosis in sagittal alignment.
骨质疏松性脊柱骨折常见于低骨密度的老年患者。在这些情况下，经皮椎体成形术或经皮后凸成形术可提供显著的疼痛缓解并改善活动能力。然而，研究报告称椎体成形术后指数水平的椎体压缩骨折复发，以及在没有任何额外创伤的情况下相邻水平发生新的椎体骨折。椎弓根螺钉固定联合经皮椎体成形术已被提出作为治疗骨质疏松性胸腰椎骨折的有效方法。然而，在骨质疏松人群中，椎弓根螺钉可能会松动、拔出或迁移。目前，皮质骨轨迹螺钉固定治疗骨质疏松性骨折的疗效尚不清楚。因此，我们评估了皮质骨轨迹器械结合经皮椎体成形术治疗骨质疏松性骨折的效果。
我们回顾性分析了 12 例连续接受皮质骨轨迹器械结合经皮椎体成形术治疗的骨质疏松性胸腰椎骨折患者的数据。患者于 2015 年 10 月开始入组，并随访>24 个月。
平均年龄为 74 岁，平均双能 X 线吸收仪 T 评分-3.6。手术后平均视觉模拟评分疼痛从 8 分改善至 2.5 分。平均出血量为 36.25 毫升。所有患者术后均恢复行走能力，疼痛减轻。随访期间无再发骨折或器械失败。
我们的研究结果表明，皮质骨轨迹器械结合经皮椎体成形术可能是治疗骨质疏松性胸腰椎骨折的一种较好选择，因为它可以防止复发性椎体骨折或相关矢状位后凸畸形。
