Pawar Abhijit, Badhe Vivek, Gawande Mohan
Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital, Four Bungalow, Andheri (W), Mumbai, India
Centre for Bone and Joint, Kokilaben Dhirubhai Ambani Hospital, Four Bungalow, Andheri (W), Mumbai, India.
Int J Spine Surg. 2022 Jun;16(3):465-471. doi: 10.14444/8243.
Osteoporotic compression fractures often progress to neurological impairment and severe pain, which results in restriction of mobility in elderly patients. Conventional open spinal decompression and stabilization in these patients have significant morbidities related to age, surgical approach, and blood loss. This case series evaluates the treatment of osteoporotic compression fractures at the thoracolumbar junction with short-segment stabilization with cement-augmented fenestrated pedicle screws and vertebroplasty using a minimally invasive percutaneous technique.
Eleven patients aged 75 years or older who had osteoporotic vertebral fractures with worsening back pain and neurologic impairment were included in this study. Plain radiographs, magnetic resonance imaging, and computed tomography images of these patients were assessed. These patients underwent minimally invasive percutaneous stabilization with cement-augmented fenestrated pedicle screws and vertebroplasty with or without decompression. Preoperative and postoperative American Spinal Cord Injury Association score, visual analog scale (VAS) score, and Charlson Comorbidity Index were recorded. Cobb angle, spinal alignment, spinal canal encroachment, and anterior vertebral body height were recorded preoperatively and during each follow-up.
All patients neurologically recovered, and the VAS score significantly improved from an average of 9 before surgery to 2 immediately after surgery and 1 at final follow-up ( < 0.001). An average, local angle of kyphosis was 15° preoperatively, which decreased to 7° postoperatively ( < 0.01). The average anterior vertebral body height was 11 mm, which increased to 22 mm postoperatively ( < 0.001). No revision was required due to screw loosening or failure of construct.
We concluded that patients with osteoporotic vertebral fractures treated with short-segment stabilization with cement-augmented fenestrated pedicle screws and vertebroplasty by minimally invasive percutaneous technique are associated with good clinical outcomes during an average follow-up of 18 months after spinal surgery.
骨质疏松性压缩骨折常进展为神经功能障碍和剧痛，导致老年患者活动受限。这些患者传统的开放性脊柱减压和固定术与年龄、手术入路及失血相关的严重并发症。本病例系列评估采用骨水泥强化开窗椎弓根螺钉短节段固定及经皮微创椎体成形术治疗胸腰段骨质疏松性压缩骨折。
本研究纳入11例75岁及以上的骨质疏松性椎体骨折且背痛加重和神经功能障碍的患者。对这些患者的X线平片、磁共振成像和计算机断层扫描图像进行评估。这些患者接受了骨水泥强化开窗椎弓根螺钉微创经皮固定及椎体成形术，可选择是否行减压。记录术前及术后美国脊髓损伤协会评分、视觉模拟评分（VAS）及Charlson合并症指数。记录术前及每次随访时的Cobb角、脊柱对线、椎管侵占及椎体前缘高度。
所有患者神经功能均恢复，VAS评分从术前平均9分显著改善至术后即刻的2分及末次随访时的1分（P<0.001）。术前平均局部后凸角为15°，术后降至7°（P<0.01）。术前椎体前缘平均高度为11mm，术后增至22mm（P<0.001）。未因螺钉松动或内固定失败而进行翻修。
我们得出结论，采用骨水泥强化开窗椎弓根螺钉短节段固定及经皮微创椎体成形术治疗骨质疏松性椎体骨折的患者，在脊柱手术后平均18个月的随访期间临床效果良好。
