Joshi Deepak, Kakadiya Ghanshyam, Attar Umair
Spine Surgeon, Department of Spine Surgery, Fortis Hospital, Sector 63, Mohali, India.
Orthopaedic Surgeon, Fortis Hospital, Sector 63, Mohali, India.
N Am Spine Soc J. 2022 Mar 16;10:100111. doi: 10.1016/j.xnsj.2022.100111. eCollection 2022 Jun.
To evaluate the safety and efficacy of vertebroplasty with short segmented cement augmented pedicle screws fixation for severe osteoporotic vertebral compression fractures (OVCF) with posterior/anterior wall fracture patients.
A retrospective study of 48 patients of DGOU type-4 (vertebra plana) OVCF with posterior/anterior wall fracture, were treated by vertebroplasty and short segment PMMA cement augmented pedicle screws fixation. Radiological parameters (kyphosis angle and compression ratio) and clinical parameters Visual analogue scale (VAS) and Oswestry disability index (ODI) were analysed.
A significant improvement was noted in VAS (preoperative, 7.90±0.60; final follow-up 2.90±0.54) and ODI (77.10±6.96 to 21.30±6.70), (<0.05). Neurological improvement was noted in all patients. Kyphosis corrected significantly from preoperative 23.20±5.90 to 5.30±1.40 postoperative with 5% (3.30±2.95) loss of correction at final follow-up. Anterior vertebral height restored significantly from 55.80±11.9% to 87.6±13.1% postoperative with 4.5±4.0% loss at final follow-up. Two cases of cement leakage were found, but both patients were asymptomatic. One patient had implant backout, one had Screw breakage and two had proximal junction kyphosis at final follow-up. No iatrogenic dural or nerve injury.
Treatment with vertebroplasty with cement augmented screw fixation and direct decompression is a great option in treating such a complex situation in fragile age with fragile bones because. Vertebroplasty is a viable option for restoring vertebral anterior columns in patients who are considered as contraindications for vertebroplasty, like DGOU-4. It provides anterior support avoiding corpectomy, minimise blood loss, and also the duration of surgery. The addition of short segment fixation gives adequate support with less stress risers at the junctional area.
评估短节段骨水泥增强椎弓根螺钉固定椎体成形术治疗伴有后壁/前壁骨折的严重骨质疏松性椎体压缩骨折（OVCF）患者的安全性和有效性。
对48例DGOU 4型（椎体扁平）伴有后壁/前壁骨折的OVCF患者进行回顾性研究，采用椎体成形术和短节段聚甲基丙烯酸甲酯（PMMA）骨水泥增强椎弓根螺钉固定治疗。分析影像学参数（后凸角和压缩率）以及临床参数视觉模拟评分法（VAS）和奥斯维斯特残疾指数（ODI）。
VAS（术前7.90±0.60；末次随访2.90±0.54）和ODI（77.10±6.96至21.30±6.70）有显著改善（<0.05）。所有患者神经功能均有改善。后凸畸形从术前的23.20±5.90显著矫正至术后的5.30±1.40，末次随访时矫正丢失5%（3.30±2.95）。椎体前缘高度从术后的55.80±11.9%显著恢复至87.6±13.1%，末次随访时丢失4.5±4.0%。发现2例骨水泥渗漏，但患者均无症状。末次随访时1例患者植入物退出，1例螺钉断裂，2例近端交界区后凸。无医源性硬脊膜或神经损伤。
骨水泥增强螺钉固定椎体成形术联合直接减压治疗这种老年脆性骨复杂情况是一个很好的选择。椎体成形术对于那些被视为椎体成形术禁忌证的患者，如DGOU-4型，是恢复椎体前柱的可行选择。它提供前路支撑，避免椎体次全切除术，减少失血，缩短手术时间。短节段固定的加入在交界区提供了足够的支撑，应力集中较小。
