Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland.
J Neurointerv Surg. 2021 Jan;13(1):63-68. doi: 10.1136/neurintsurg-2020-016597. Epub 2020 Sep 16.
The treatment of severe osteoporotic vertebral compression fractures (VCFs) with middle-column (MC) involvement, high fragmentation, large cleft and/or pedicular fracture is challenging. Minimally invasive 'stent-screw-assisted internal fixation' (SAIF) can reduce the fracture, reconstruct the vertebral body (VB) and fix it to the posterior elements.
To assess feasibility, safety, technical and clinical outcome of the SAIF technique in patients with severe osteoporotic VCFs.
80 treated vertebrae were analyzed retrospectively. Severe VCFs were characterized by advanced collapse (Genant grade 3), a high degree of osseous fragmentation (McCormack grade 2 and 3), burst morphology with MC injury, pediculo-somatic junction fracture, and/or large osteonecrotic cleft. VB reconstruction was evaluated on postprocedure radiographs and CT scans by two independent raters. Clinical and radiological follow-ups were performed at 1 and 6 months.
SAIF was performed at 28 thoracic and 52 lumbar levels in 73 patients. One transient neurological complication occurred. VB reconstruction was satisfactory in 98.8% of levels (inter-rater reliability 96%, κ=1). Follow-up at 1 month was available for 78/80 levels and at 6 months or later (range 6-24, mean 7.9 months) for 73/80 levels. Significant improvement in the Visual Analog Scale score was noted at 1 and 6 months after treatment (p<0.05). Patients reported global clinical benefit during follow-up (Patient's Global Impression of Change Scale 5.6±0.9 at 1 month and 6.1±0.9 at 6 months). Fourteen new painful VCFs occurred at different levels in 11 patients during follow-up, treated with vertebral augmentation or SAIF. Target-level stability was maintained in all cases.
SAIF is a minimally invasive, safe, and effective treatment for patients with severe osteoporotic VCFs with MC involvement.
治疗伴有中柱（MC）受累、高度碎裂、大裂隙和/或椎弓根骨折的严重骨质疏松性椎体压缩性骨折（VCF）具有挑战性。微创“支架螺钉辅助内固定（SAIF）”可减少骨折、重建椎体（VB）并将其固定到后柱。
评估 SAIF 技术在伴有严重骨质疏松性 VCF 的患者中的可行性、安全性、技术和临床疗效。
回顾性分析 80 个治疗椎体。严重 VCF 的特征为严重塌陷（Genant 分级 3）、高度骨碎裂（McCormack 分级 2 和 3）、爆裂形态伴 MC 损伤、椎弓根-体交界处骨折和/或大骨坏死裂隙。VB 重建在术后 X 线和 CT 扫描上由两名独立的评分者进行评估。在 1 个月和 6 个月时进行临床和影像学随访。
在 73 名患者的 28 个胸椎和 52 个腰椎中进行了 SAIF。发生 1 例短暂性神经并发症。98.8%的节段 VB 重建满意（评分者间可靠性 96%，κ=1）。80 个节段中有 78 个可获得 1 个月随访，73 个可获得 6 个月或更晚随访（范围 6-24 个月，平均 7.9 个月）。治疗后 1 个月和 6 个月，视觉模拟量表评分显著改善（p<0.05）。患者在随访期间报告了总体临床获益（治疗后 1 个月患者总体印象变化量表 5.6±0.9，6 个月时 6.1±0.9）。11 名患者在随访期间不同节段出现 14 例新发疼痛性 VCF，采用椎体强化或 SAIF 治疗。所有病例均保持目标节段稳定性。
SAIF 是治疗伴有 MC 受累的严重骨质疏松性 VCF 的一种微创、安全、有效的方法。
