Fujii Kengo, Setojima Yusuke, Ogawa Kaishi, Li Sayori, Funayama Toru, Yamazaki Masashi
Department of Orthopaedic Surgery, Showa General Hospital, Tokyo, Japan.
Department of Orthopaedic Surgery, University of Tsukuba, Tsukuba, Japan.
Spine Surg Relat Res. 2024 Apr 3;8(6):600-607. doi: 10.22603/ssrr.2023-0296. eCollection 2024 Nov 27.
Percutaneous vertebral augmentation techniques, such as balloon kyphoplasty (BKP) and vertebral body stenting (VBS), are commonly used for surgical intervention in osteoporotic vertebral fractures (OVFs). However, markedly unstable OVF cases require additional fixation procedures, prompting the exploration of combined percutaneous vertebral augmentation and posterior fixation. A novel surgical approach involving percutaneous vertebral augmentation with upward penetrating endplate screws (PES) and downward PES, complemented by a short fusion of one above one below, was developed. This study aimed to introduce and report the preliminary outcomes of this technique based on a retrospective analysis of 20 consecutive cases in the short and medium term.
Surgical indications are a vertebral wedge angle difference of 10° or more, vertebral pedicle fractures, posterior wall fractures, and diffuse low-signal changes exceeding 50% on T1-weighted magnetic resonance imaging. The procedure is reserved for highly unstable cases following a comprehensive health assessment. The surgical technique involves prone positioning, fluoroscopy-guided percutaneous vertebral augmentation, and the use of downward PES in the cranial vertebral body and upward PES for the caudal vertebral body by percutaneous technique. The fixation range is one above and one below.
The case series of 20 patients, with an average follow-up period of 146.9 days, demonstrates a mean surgical time of 57 min and minimal complications. The advantages of the technique are as follows: ease of performance, minimal fixation range, and time efficiency. Risks, such as potential screw loosening and the need for prolonged follow-up, are acknowledged.
The technique represents a promising surgical approach that balances the requirements of minimally invasive intervention and relatively robust initial fixation for elderly osteoporotic patients with unstable OVFs. While short- and medium-term results are favorable, long-term observations are needed to further assess its efficacy. This novel technique has a potential to be a valuable surgical option for unstable OVFs.
经皮椎体强化技术，如球囊椎体后凸成形术（BKP）和椎体支架置入术（VBS），常用于骨质疏松性椎体骨折（OVF）的手术干预。然而，明显不稳定的OVF病例需要额外的固定程序，这促使人们探索经皮椎体强化与后路固定相结合的方法。一种新的手术方法应运而生，该方法包括经皮椎体强化联合向上穿透终板螺钉（PES）和向下的PES，并辅以相邻椎体间的短节段融合。本研究旨在通过对20例连续病例的短期和中期回顾性分析，介绍并报告该技术的初步结果。
手术适应证为椎体楔角差10°或以上、椎弓根骨折、后壁骨折以及T1加权磁共振成像上超过50%的弥漫性低信号改变。该手术仅适用于经过全面健康评估的高度不稳定病例。手术技术包括俯卧位、透视引导下的经皮椎体强化，以及通过经皮技术在头侧椎体使用向下的PES，在尾侧椎体使用向上的PES。固定范围为相邻椎体。
20例患者的病例系列，平均随访期为146.9天，平均手术时间为57分钟，并发症极少。该技术的优点如下：操作简便、固定范围小、时间效率高。同时也认识到存在潜在的螺钉松动等风险以及需要长期随访。
该技术是一种有前景的手术方法，平衡了老年骨质疏松性不稳定OVF患者对微创干预和相对牢固初始固定的需求。虽然短期和中期结果良好，但需要长期观察以进一步评估其疗效。这种新技术有可能成为不稳定OVF的一种有价值的手术选择。
