Moura Diogo Lino, Gabriel Josué Pereira
Centro Hospitalar e Universitario de Coimbra, Serviço de Ortopedia, Setor de Coluna Vertebral, Coimbra, Portugal.
Universidade de Coimbra, Faculdade de Medicina, Instituto de Anatomia e Clinica Universitaria de Ortopedia, Coimbra, Portugal.
Acta Ortop Bras. 2023 Jul 31;31(4):e262943. doi: 10.1590/1413-785220233104e262943. eCollection 2023.
The progressive evolution of post-traumatic vertebral necrosis and consequent loss of structural integrity of the vertebral body along with neurological risk, makes it one of the most feared and unpredictable pathologies in spine traumatology. Several studies have addressed the role of vertebroplasty, kyphoplasty, and corpectomy in its treatment; however, it remains a controversial concept without a defined therapeutic algorithm. The recent emergence of expandable intravertebral implants, which allow, by a percutaneous transpedicular application, the capacity for intrasomatic filling and maintenance of the height of the vertebral body, makes them a viable option, not only in the treatment of acute vertebral fractures, but also in non-union cases. In this study, we present a review of the current evidence on the application of expandable intravertebral implants in cases of post-traumatic vertebral necrosis. Based on the available scientific literature, including previous classifications of post-traumatic necrosis, and on the mechanical characteristics of the main expandable intravertebral implants currently available, we propose a simplified classification of this pathology, considering parameters that influence surgical therapeutic guidance, the morphology and the dynamics of the necrotic vertebra's mobility. According to its stages and based on authors' experience and on the scarce literature, we propose an initial therapeutic algorithm and suggest preventive strategies for this disease, considering its main risk factors, that is, fracture comminution and impairment of vertebral vascularity. Therefore, expandable intravertebral implants have a promising role in this condition; however, large prospective studies are needed to confirm their efficacy, to clarify the indications of each of these devices, and to validate the algorithm suggestion regarding treatment and prevention of post-traumatic vertebral necrosis.
创伤后椎体坏死的渐进性演变以及随之而来的椎体结构完整性丧失和神经学风险，使其成为脊柱创伤学中最令人恐惧且难以预测的病症之一。多项研究探讨了椎体成形术、后凸成形术和椎体切除术在其治疗中的作用；然而，它仍然是一个存在争议的概念，没有明确的治疗方案。可膨胀椎体内植入物的近期出现，通过经皮椎弓根应用，能够实现体内填充并维持椎体高度，这使其不仅成为治疗急性椎体骨折的可行选择，也适用于骨不连病例。在本研究中，我们对可膨胀椎体内植入物在创伤后椎体坏死病例中的应用的现有证据进行了综述。基于现有的科学文献，包括先前的创伤后坏死分类，以及当前可用的主要可膨胀椎体内植入物的力学特性，我们提出了这种病症的简化分类，考虑影响手术治疗指导、坏死椎体活动度的形态和动态的参数。根据其阶段，并基于作者的经验和稀少的文献，我们提出了初步的治疗方案，并针对该疾病的主要危险因素，即骨折粉碎和椎体血管损伤，提出了预防策略。因此，可膨胀椎体内植入物在这种情况下具有广阔的应用前景；然而，需要大型前瞻性研究来证实其疗效，明确每种器械的适应症，并验证关于创伤后椎体坏死治疗和预防的方案建议。
