No abstract

Minimally invasive spine surgery (MISS), including percutaneous pedicle-screw fixation (PPSF), mini-open transforaminal lumbar interbody fusion (m-open TLIF), vertebroplasty, and stentoplasty, allows the preservation of neurological function and the restoration of spine stability, while reducing associated risks and complications. This study aimed to analyze the safety and efficacy of MISS in elderly patients suffering from degenerative or traumatic thoracolumbar diseases. Forty-five patients (28 females), with a mean age of 73 years (range 65-89), suffering from osteoporotic vertebral fractures (24), degenerative spondylolisthesis (15), and lumbar canal stenosis with instability and/or de novo scoliosis (6) were included.Twenty-one patients underwent PPSF and m-open TLIF. The remaining patients received PPSF without interbody fusion, and in six of these fenestrated screws were used for vertebral body cement augmentation.Functional evaluation was obtained with a visual analog scale (VAS) and the Oswestry Disability Index (ODI) pre- and postoperatively. Preoperative imaging included X-rays, computed tomography (CT), and magnetic resonance imaging (MRI). Patients were followed-up with X-rays, and a CT scan was also obtained at the last follow-up. Follow-up ranged from 6 to 59 months (mean 28 months). Follow-up CT scan documented intersomatic fusion in only 14 % of patients treated with m-open TLIF. Despite the high incidence of non-union, mean VAS and ODI scores showed a significant improvement, with a reduction of mean VAS from 9 to 4 and a reduction of mean ODI from 76.33 to 38.15 %. Only three patients developed postoperative complications. No patients showed neurological deficits.Minimally invasive spine surgery for degenerative and traumatic spinal diseases is a safe and effective treatment also in elderly patients.

This series demonstrates that MIS is feasible and effective for LDLLS, as witnesses by the satisfactory clinical results maintained at medium-term follow-up. We submit that TLIF is a valid option but an adequately sized and positioned interbody cage is a key factor to allow satisfactory restoration of segmental lordosis.

BackgroundSeveral techniques have been developed for simpler and safer procedures during the last 2 decades. Techniques of vertebral body augmentation have been developed in an effort to treat these refractory cases. The injection of low-viscosity poly-methylemethacrylate (PMMA) under high pressure poses a potential risk for neural compromise and pulmonary embolism by uncontrolled leakage. Therefore, balloon kyphoplasty and vertebroplasty using a large cannula low pressure injection of PMMA in a high-viscosity state has been introduced. Percutaneous kyphoplasty (PKP) is a recently developed, minimally invasive surgical approach for the treatment of osteoporotic vertebral compression fractures (OVCF). ObjectiveOur objective is directed towards the study of the role of kyphoplasty in the management of osteoporotic thoracolumbar fractures, following the analysis of clinical and radiographic outcomes. Our objective is to evaluate the efficacy and safety of kyphoplasty in the treatment of acute vertebral osteoporotic compression fractures and to validate the hypothesis that kyphoplasty will help diminish pain, disability and improve the quality of life (QoL). The goal of this study was to determine the safety and effectiveness of kyphoplasty in improving vertebral body height, decreasing pain, and improving affected functions. Patients and MethodsA prospective analysis of 30 patients (10 males and 20 females), being treated with kyphoplasty, was performed at our institution, after a clinical follow-up of 6 months. The patients had vertebral compression fractures (VCFs) at levels T7 to L4 due to osteoporosis arising from primary and secondary etiological factors. There were 41 VCFs in these 30 patients. The median age was 69 years (range 53-87 years). Subjects were excluded if they had associated spinal stenosis, neurologic deficit, an active infection, and severe comorbidities, such as uncorrected coagulopathy. ResultsAccording to the pain scores, 26 (87%) patients showed a drastic post-operative improvement whereas, in 2 cases, significant improvement was noted after a follow-up in 3 months. On the other hand, 2 (7%) patients showed a deteriorated pain score. 24 (80%) patients showed constant improvement over a period of 6 months. 7 patients (23%) showed further improvement after the 6 months clinical follow-up. ConclusionAll PMMA extravasations were asymptomatic; the cement was observed at a close vicinity to the treated vertebrae. We treated 41 fractures with balloon kyphoplasty (BKP); however, the failure of balloon distension occurred in 6 fractures (14%), which were managed with conventional vertebroplasty; Therefore, the exact cause behind the failure of the procedure is still unclear.