Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
Department for Radiology, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
Arch Orthop Trauma Surg. 2023 May;143(5):2333-2339. doi: 10.1007/s00402-022-04434-0. Epub 2022 Apr 11.
Osteoporotic vertebral fractures are a major healthcare problem. Vertebral cement augmentation (VCA) is frequently used as a minimally invasive surgical approach to manage symptomatic fractures. However, there is a potential risk of adjacent segment fracture (ASF), which may require second surgery. The addition of transcutaneous screw-fixation with cement augmentation superior and inferior to the fracture [Hybrid transcutaneous screw fixation (HTSF)] might represent an alternative treatment option to reduce the incidence of ASF.
We retrospectively compared surgery time, hospital stay, intraoperative complication rate and the occurrence of ASF with the need for a surgical treatment in a cohort of 165 consecutive patients receiving either VCA or HTSF in our academic neurosurgical department from 2012 to 2020. The median follow-up was 52.3 weeks in the VCA-group and 51.9 in the HTSF-group.
During the study period, 93 patients underwent VCA, and 72 had HTSF. Of all patients, 113 were females (64 VCA; 49 HTSF) and 52 were males (29 VCA; 23 HTSF). The median age was 77 years in both groups. Median surgery time was 32 min in the VCA-group and 81 min in the HTSF-group (p < 0.0001). No surgery-related complications occurred in the VCA-group with two in the HTSF-group (p = 0.19). ASF was significantly higher in the VCA-group compared to HTSF (24 [26%] vs. 8 [11%] patients; p < 0.02). The proportion of patients requiring additional surgery due to ASF was higher in the VCA-group (13 vs. 6%), but this difference was not statistically significant (p = 0.18). Median hospital stay was 9 days in the VCA-group and 11.5 days in the HTSF-group (p = 0.0001).
Based on this single-center cohort study, HTSF appears to be a safe and effective option for the treatment of osteoporotic vertebral compression fractures. Surgical time and duration of hospital stay were longer in the HTSF-group, but the rate of ASF was significantly reduced with this approach. Further studies are required to ascertain whether HTSF results in superior long-term outcomes or improved quality of life.
骨质疏松性椎体骨折是一个主要的医疗保健问题。椎体骨水泥强化（VCA）经常被用作治疗有症状骨折的微创外科方法。然而，存在相邻节段骨折（ASF）的潜在风险，这可能需要进行第二次手术。在骨折的上下方附加经皮螺钉固定和骨水泥强化[混合经皮螺钉固定（HTSF）]可能是降低 ASF 发生率的另一种治疗选择。
我们回顾性比较了 2012 年至 2020 年在我们的神经外科学术部门连续接受 VCA 或 HTSF 的 165 例连续患者的手术时间、住院时间、术中并发症发生率和需要手术治疗的 ASF 发生率。VCA 组的中位随访时间为 52.3 周，HTSF 组为 51.9 周。
在研究期间，93 例患者接受了 VCA，72 例患者接受了 HTSF。所有患者中，113 例为女性（64 例 VCA；49 例 HTSF），52 例为男性（29 例 VCA；23 例 HTSF）。两组患者的中位年龄均为 77 岁。VCA 组的中位手术时间为 32 分钟，HTSF 组为 81 分钟（p<0.0001）。VCA 组无手术相关并发症，HTSF 组有 2 例（p=0.19）。VCA 组的 ASF 发生率明显高于 HTSF 组（24[26%]例比 8[11%]例；p<0.02）。由于 ASF 需要进一步手术的患者比例在 VCA 组较高（13 例比 6%），但差异无统计学意义（p=0.18）。VCA 组的中位住院时间为 9 天，HTSF 组为 11.5 天（p=0.0001）。
基于这项单中心队列研究，HTSF 似乎是治疗骨质疏松性椎体压缩性骨折的一种安全有效的选择。HTSF 组的手术时间和住院时间较长，但该方法的 ASF 发生率显著降低。需要进一步的研究来确定 HTSF 是否会带来更好的长期结果或提高生活质量。
