The use of unilateral pedicle screw reduction combined with percutaneous kyphoplasty in the treatment of osteoporotic compression vertebral fracture with disrupted posterior vertebral walls

English Keywords:Osteoporosis  Vertebral compressed fracture  Pedicle screw  Percutaneous kyphoplasty

English Abstract:

  【Abstract】 Objectives: To assess the effectiveness of temporary unilateral pedicle screw reduction combined with percutaneous kyphoplasty as a new procedure for the management of osteoporotic compression vertebral fracture (OVCF) with disrupted posterior vertebral wall (DPVW). Methods: From January 2012 to December 2014, 35 patients with OVCF and DPVW without neurologic damage underwent the proposed procedure in our centre, including 30 females and 5 males with an average age of 65.5±7.13 years (range, 55-80 years). All fractures were single-level, ranging from T11 to L4. For each case, radiographic results (Cobb angle and the height of vertebrae), the pain score and daily function were compared before and after surgery. Results: On average, the surgery time was 78.33±13.94 minutes, the volume of cement injected was 5.10±1.13ml, and the blood loss was 18.80±5.29ml. There were 2 cases of cement leakage, one into the lateral side, the other into the disc space. The average follow-up period was 15±5.50 months(12-24 months). The average preoperative vertebral Cobb angle was 16.25°±6.50°; anterior height was 0.62±0.17 and central height was 0.63±0.09; the correspondent part at final follow-up was 12.26°±5.14°, 0.71±0.11 and 0.70±0.14 successively, which were significantly improved after surgery(P＜0.05). VAS scores of patients were 8.03±1.61, Oswestry disability index was 0.73±0.17, and 0.60±0.74 and 0.10±0.04 successively at final follow-up, which were significantly improved after surgery(P＜0.05). Conclusions: For patients with OVCF and DPVW, temporary unilateral pedicle screw reduction combined with percutaneous kyphoplasty can restore the height of fractured vertebrae, decrease the risk of cement leakage and improve clinical outcome.