Treatment of Osteoporotic Compression Fractures at Thoracolumbar Spine With Neurodeficit: Short-Segment Stabilization With Cement-Augmented Fenestrated Pedicle Screws and Vertebroplasty by Minimally Invasive Percutaneous Technique

Abstract

Background: 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.Methods: 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 cementaugmented 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.Results: 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 (P < 0.001). An average, local angle of kyphosis was 15° preoperatively, which decreased to 7° postoperatively (P < 0.01). The average anterior vertebral body height was 11 mm, which increased to 22 mm postoperatively (P < 0.001). No revision was required due to screw loosening or failure of construct. Conclusion: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.

Biomechanical behaviour of a novel bone cement screw in the minimally invasive treatment of Kummell's disease: a finite element study

“…In the three postoperative models, the maximum stress of bone cement was 38.95 MPa, which was in the safe value. What’s more, yield strength of titanium nail rod was 825-895 MPa, and the destruction intensity of human cortical bone was between 90–200 MPa [ 5 ]. In this paper, the maximum stress of bone cement screws in six directions was 177.1 MPa, and the maximum stress of endplate was 43.42 MPa.…”

“…Anchoring of bone cement with internal fixation is a new way to treat KD. Pedicle screws have been widely used in clinical practice, and their safety and firmness have been confirmed [ 5 ]. The implantation technique of pedicle screw is combined with PVP.…”