Clinical efficacy on the treatment of thoracolumbar fracture using a homemade bone graft funnel for injured vertebral bone graft combined with percutaneous pedicle screw internal fixation

English Keywords:Thoracic vertebrae  Lumbar vertebrae  Fracture  Bone transplantation

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacy of using a homemade minimally invasive percutaneous bone graft funnel for the treatment of thoracolumbar vertebral fractures with injured vertebral bone graft in combination with percutaneous pedicle screw internal fixation. Methods: Clinical data from 26 patients with thoracolumbar spine fractures without nerve injury admitted and treated between January 2020 and June 2021 were retrospectively analyzed. There were 13 males and 13 females, aged 51.23±9.56 years(33-65 years old). All the patients were single-segment injury, and there were 2 cases of T12, 8 cases of L1, 8 cases of L2, 5 cases of L3, and 3 cases of L4. Internal fixation was performed using percutaneous pedicle screw fixation across the injured vertebrae, followed by internal implantation of autologous iliac bone into the injured vertebrae via a homemade minimally invasive bone graft funnel. The operative time, intraoperative bleeding and complications were recorded; The visual analogue scale(VAS) of pain, Oswestry disability index(ODI), compression ratios of the anterior and middle heights of the injured vertebrae, and sagittal Cobb angle were observed and statistically analyzed before operation and at 1 week after operation and final follow-up. Results: All the patients were successfully operated with a follow-up of 12-22 months(15.19±2.51 months). The operative time was 84.62±12.88min, blood loss was 55.58±12.44mL. There were no complications such as wound infection and spinal cord injury, and one patient presented with caudal adventitial loosening of a screwed pedicle. Compared with the preoperative period, the postoperative 1 week and final follow-up anterior height compression rate[(6.89±7.25)%, (10.28±7.50)%] and mid-height compression rate[(7.11±5.75)%, (10.63±6.24)%] of the injured vertebrae, Cobb angle(4.38°±7.77°, 2.14°±7.78°), VAS score(3.35±0.56, 1.73±0.45) and ODI [(41.96±3.82)%, (13.77±2.42)%] were significantly improved(P<0.05). Compared with 1 week postoperatively, at the final follow-up, the patients had a slight increase in the compression rate of the anterior[(10.28±7.50)%] and middle[(10.63±6.24)%] heights of the injured vertebral body, a slight decrease in the Cobb angle(2.14°±7.78°) and a significant improvement in VAS scores(1.73±0.45) and ODI[(13.77±2.42)%](P<0.05). Conclusions: For patients with thoracolumbar fractures without nerve injury, using a homemade minimally invasive bone graft funnel for transforaminal bone grafting in combination with percutaneous pedicle screws can effectively restore the vertebral body height and correct the kyphosis deformity.