Treatment of Osteoporotic Thoracolumbar Burst Fractures by Bilateral Pedicle Vertebroplasty Combined With Postural Reduction

Abstract

Background: Osteoporotic thoracolumbar burst fracture (OTLBF) is common in seniors. Due to the fracture of the posterior vertebra and spinal canal occupancy, the risk of cement leakage and spine injury is high in OTLBF patients, thus the application of vertebroplasty is limited in these patients. This study aims to investigate the efficacy and safety of vertebroplasty for treating OTLBF via bilateral pedicle approach combined with postural reduction. To determine whether percutaneous vertebroplasty (PVP) combined with body reduction is an alternative method for treating OTLBF that prevents major surgical complications.Methods: Thirteen patients (aged≥65years) with thoracolumbar fractures but without neurological deficits underwent vertebroplasty. In all fracture cases, the anterior and middle columns of the vertebrae were affected and the canal was mildly compressed. To assess the clinical symptoms and the effects of the procedure, patient mobility and pain were assessed prior to the procedure and at 1 day and 3 months after the procedure. Kyphosis correction, wedge angle, and height restoration were also observed and measured. Results: Improvements in pain and mobility were observed immediately after vertebroplasty in all patients. These results were observed for 6 months. Significant improvements were also noted at 1 day and 6 months after vertebroplasty. Pain was reduced by at least 4 levels after 6 months. No comorbidities were observed. Kyphosis Correction, Wedge Angle and height recovery were improved. Postoperative computed tomography revealed polymethylmethacrylate leakage through the endplate fracture site into the disc space and paravertebral spacein one patient. No intraspinal leakage was found in all patients. Conclusions: Vertebroplasty is assumed to be contraindicated in patients with osteoporotic thoracolumbar fractures with posterior body involvement. However, this procedure was successfully performed to safely treat such fractures without causing neurological deficits. PVP combined with body reduction may be an alternative method for treating OTLBF that prevents major surgical complications. Moreover, it helps patients achieve early mobilization and pain relief.