Hishiya Takahisa, Ishikawa Tetsuhiro, Ota Mitsutoshi
1Orthopedic Surgery, Sanmu Medical Center, Chiba, Japan; and.
2Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
J Neurosurg Spine. 2021 Apr 9;34(6):936-941. doi: 10.3171/2020.10.SPINE201387. Print 2021 Jun 1.
Diffuse idiopathic skeletal hyperostosis (DISH)-related vertebral fractures essentially require operative treatment due to severe fracture site instability and high potential risk of posttraumatic neurological deficit. However, the optimal surgical procedure remains unclear. The purpose of this study was to assess the efficacy of posterior spinal fixation with penetrating endplate screws (PESs) for DISH-related thoracolumbar fractures.
The authors conducted a retrospective, single-center, observational study. They included data from 26 consecutive patients with DISH-related thoracolumbar fractures who were treated with posterior spinal fixation using either conventional pedicle screws (PS group, n = 8) or a combined PES technique (PES group, n = 18) between 2013 and 2019. Age, sex, BMI, bone mineral density, fracture level, use of antithrombotic drug, blood loss, operation time, fixation range, perioperative American Spinal Injury Association Impairment Scale score, implant failure, revision surgery, complications, and mortality were compared. The authors also evaluated screw loosening and bone healing on radiographs and CT scans.
More patients had vertebral fractures in the lumbar spine in the PS group than in the PES group (3 vs 0; p = 0.019). Patients in the PES group had less blood loss (63 vs 173 ml; p = 0.048) and shorter range of fixation (5 vs 5.5 levels; p = 0.041). The screw loosening rate was significantly lower in the PES group than in the PS group (3% vs 49%; p < 0.001).
Posterior spinal fixation using a PES technique may be an ideal surgical procedure for thoracolumbar fractures with DISH, providing more rigid and less invasive fixation than PS.
由于骨折部位严重不稳定以及创伤后神经功能缺损的高潜在风险，弥漫性特发性骨肥厚（DISH）相关的椎体骨折基本上需要手术治疗。然而，最佳手术方法仍不明确。本研究的目的是评估使用穿透终板螺钉（PES）进行后路脊柱固定治疗DISH相关胸腰椎骨折的疗效。
作者进行了一项回顾性、单中心观察性研究。纳入了2013年至2019年间连续26例接受后路脊柱固定治疗的DISH相关胸腰椎骨折患者的数据，其中8例使用传统椎弓根螺钉（PS组），18例使用PES联合技术（PES组）。比较了年龄、性别、体重指数、骨密度、骨折节段、抗血栓药物使用情况、失血量、手术时间、固定范围、围手术期美国脊髓损伤协会损伤分级评分、植入物失败、翻修手术、并发症和死亡率。作者还在X线片和CT扫描上评估了螺钉松动和骨愈合情况。
PS组腰椎椎体骨折的患者比PES组多（3例对0例；p = 0.019）。PES组患者的失血量较少（63 ml对173 ml；p = 0.048），固定节段范围较短（5个节段对5.5个节段；p = 0.041）。PES组的螺钉松动率显著低于PS组（3%对49%；p < 0.001）。
使用PES技术进行后路脊柱固定可能是治疗DISH相关胸腰椎骨折的理想手术方法，与PS相比，提供了更坚固且侵入性更小的固定。
