Department of Spine Surgery, Ningbo No.6 Hospital, Zhong Shan East Road 1059#, Ningbo, Zhejiang Province, China.
Department of Spine Surgery, Ningbo No.6 Hospital, Zhong Shan East Road 1059#, Ningbo, Zhejiang Province, China.
Orthop Traumatol Surg Res. 2021 Nov;107(7):102796. doi: 10.1016/j.otsr.2020.102796. Epub 2020 Dec 15.
Cement augmentation has been proven to be a safe procedure for the treatment of osteoporotic vertebral fracture, and the overall result is encouraging. However, failures caused by different complications are not uncommon, and a few patients even need revision surgery. This retrospective study aimed to investigate the primary causes of revision surgery after cement augmentation for osteoporotic vertebral fracture and how to prevent them, and the second objective was to evaluate the clinical results of revision surgery.
The main hypothesis is that infection and neurological dysfunction are the prime causes of revision surgery after cement augmentation for osteoporotic vertebral fracture, and the second hypothesis is that revision surgery is effective to improve the quality of daily life.
Twenty-one patients who underwent unplanned revision surgery after cement augmentation were retrospectively analyzed. The initial radiographic and medical records were reviewed to re-evaluate whether the initial diagnosis and surgical procedure were correct and suitable. The primary causes of revision surgery and the details were recorded. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were used to evaluate the efficacy of the revision surgery, and patients with neurological dysfunction were evaluated with the American Spinal Injury Association (ASIA).
A total of 47.6% (10/21) of patients were misdiagnosed initially or had an incorrect indication for cement augmentation surgery, including 3 pre-existing spondylitis cases that were misdiagnosed as osteoporotic vertebral fracture and 7 cases of three column fractures that were treated with cement augmentation. The primary causes and details of the revision surgeries were as follows: 7 patients with infection underwent anterior and/or posterior debridement and fixation; 9 patients with progressive kyphosis underwent posterior osteotomy and fixation; and 5 patients with neurological dysfunction underwent posterior decompression and fixation. The mean follow-up time was 30.6±8.7 months, the VAS score decreased from 7.3±1.1 preoperatively to 2.3±0.3 (p<0.05) at the last follow-up, the ODI decreased from 61.1%±16.3% preoperatively to 20.6%±6.2% (p<0.05) at the last follow-up, and 5 patients with neurological dysfunction improved by at least one grade.
Infection, progressive kyphosis and neurological dysfunction are the primary causes of revision surgery after cement augmentation for osteoporotic vertebral fracture. Avoiding misdiagnosis and ensuring suitable indications might be the key points to decreasing unplanned revision surgery for cement augmentation for osteoporotic vertebral fracture. The quality of daily life and neurological function can be improved through revision surgery.
骨水泥强化已被证明是治疗骨质疏松性椎体骨折的一种安全方法，总体效果令人鼓舞。然而，由于不同并发症导致的失败并不罕见，少数患者甚至需要进行翻修手术。本回顾性研究旨在探讨骨质疏松性椎体骨折骨水泥强化翻修手术的主要原因及如何预防这些原因，并评估翻修手术的临床效果。
主要假说为感染和神经功能障碍是骨质疏松性椎体骨折骨水泥强化翻修手术的主要原因，次要假说为翻修手术可有效改善日常生活质量。
对 21 例因骨质疏松性椎体骨折骨水泥强化后行非计划性翻修手术的患者进行回顾性分析。回顾性分析初始影像学和病历资料，重新评估初始诊断和手术过程是否正确和合适。记录翻修手术的主要原因和详细情况。采用视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）评估翻修手术的疗效，对神经功能障碍患者采用美国脊髓损伤协会（ASIA）评分进行评估。
共有 47.6%（10/21）的患者初始诊断或骨水泥强化手术适应证错误，包括 3 例既往存在脊椎炎的患者被误诊为骨质疏松性椎体骨折，7 例三柱骨折患者接受骨水泥强化治疗。翻修手术的主要原因和详细情况如下：7 例感染患者行前路和/或后路清创固定术；9 例进展性后凸畸形患者行后路截骨固定术；5 例神经功能障碍患者行后路减压固定术。平均随访时间为 30.6±8.7 个月，VAS 评分由术前的 7.3±1.1 分降至末次随访时的 2.3±0.3 分（p<0.05），ODI 由术前的 61.1%±16.3%降至末次随访时的 20.6%±6.2%（p<0.05），5 例神经功能障碍患者至少提高 1 个等级。
感染、进展性后凸畸形和神经功能障碍是骨质疏松性椎体骨折骨水泥强化翻修手术的主要原因。避免误诊和确保合适的适应证可能是减少骨质疏松性椎体骨折骨水泥强化非计划性翻修手术的关键。翻修手术可改善日常生活质量和神经功能。
