Funao Haruki, Isogai Norihiro, Sasao Yutaka, Nishiyama Makoto, Ishii Ken
Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Japan; Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Japan.
Department of Orthopaedic Surgery, School of Medicine, International University of Health and Welfare, Japan; Spine and Spinal Cord Center, International University of Health and Welfare Mita Hospital, Japan.
Int J Surg Case Rep. 2020;72:301-305. doi: 10.1016/j.ijscr.2020.06.009. Epub 2020 Jun 12.
Surgical treatment of osteoporotic vertebral fracture (OVF) has been challenging for spine surgeons, because there are potential risks of instrumentation failure; such as screw loosening, loss of correction, or pseudarthrosis, due to bone fragility in elderly patients with several comorbidities.
A 68-year-old female presented with a severe low back pain and bilateral thigh pain. She had a history of systemic scleroderma, which was complicated by interstitial lung disease. Although she initially underwent non-surgical treatment with bracing for 7 months, her symptoms had progressively deteriorated, and her radiographs showed non-union at L1 and progressive kyphotic deformity at the thoracolumbar spine. Because an anterior approach was inadvisable due to interstitial lung disease, vertebroplasty with posterior spinal fusion was performed using percutaneous pedicle screws (PPS) at the upper most and lowest instrumented vertebra combined with sublaminar taping and computer-assisted rod contouring system. Good bony union was achieved with no screw loosening at 1-year follow-up.
Various surgical procedures have been applied according to the fracture type or medical condition of the patient. Minimally invasive posterior spinal fusion would be a less invasive approach in patients with poor medical condition. PPS can prevent the excessive dissection of paravertebral muscles, and this is especially advantageous at the proximal and distal end of long constructs. A recent computer-assisted rod contouring system accurately matches each screw head resulting in reduced strength of the screw-bone interface.
This technique would be beneficial in the elderly or immunocompromised patients with OVF.
骨质疏松性椎体骨折（OVF）的手术治疗一直是脊柱外科医生面临的挑战，因为存在内固定失败的潜在风险；例如，由于老年患者合并多种疾病导致骨质脆弱，可能出现螺钉松动、矫正丢失或假关节形成。
一名68岁女性因严重的下背部疼痛和双侧大腿疼痛就诊。她有系统性硬皮病病史，并伴有间质性肺病。尽管她最初接受了7个月的支具非手术治疗，但症状逐渐恶化，X线片显示L1不愈合，胸腰椎出现进行性后凸畸形。由于间质性肺病，前路手术不可行，因此在最上方和最下方的固定椎体使用经皮椎弓根螺钉（PPS）结合椎板下绑扎和计算机辅助棒材塑形系统进行椎体成形术和后路脊柱融合术。1年随访时实现了良好的骨愈合，无螺钉松动。
根据骨折类型或患者的病情采用了各种手术方法。对于病情较差的患者，微创后路脊柱融合术是一种侵入性较小的方法。PPS可以避免过度解剖椎旁肌肉，这在长节段固定的近端和远端尤其有利。最近的计算机辅助棒材塑形系统能够精确匹配每个螺钉头，从而降低螺钉-骨界面的强度。
该技术对老年或免疫功能低下的OVF患者有益。
