Abstract
Background: Osteoporotic spinal fractures commonly occur in elderly patients with low bone mineral density. In these cases, percutaneous vertebroplasty or percutaneous kyphoplasty can provide significant pain relief and improve mobility. However, studies have reported both the recurrence of vertebral compression fractures at the index level after vertebroplasty and the development of new vertebral fractures at the adjacent level that occur without any additional trauma. Pedicle screw fixation combined with percutaneous vertebroplasty has been proposed as an effective procedure for addressing osteoporotic thoracolumbar fractures. However, in osteoporotic populations, pedicle screws can loosen, pullout, or migrate. Currently, the efficacy of cortical bone trajectory screw fixation for osteoporotic fractures remains unclear. Thus, we assessed the effects of using cortical bone trajectory instrumentation with vertebroplasty on patient outcomes. Method: We retrospectively reviewed data from 12 consecutively sampled osteoporotic thoracolumbar fracture patients who underwent cortical bone trajectory instrumentation with vertebroplasty. Patients were enrolled beginning in October 2015 and were followed for >24 months. Result: The average age was 74 years, and the average dual-energy x-ray absorptiometry T-score was −3.6. The average visual analog scale pain scores improved from 8 to 2.5 after surgery. The average blood loss was 36.25 mL. All patients regained ambulation and experienced reduced pain post-surgery. No recurrent fractures or instrument failures were recorded during follow-up. Conclusions: Our findings suggest that cortical bone trajectory instrumentation combined with percutaneous vertebroplasty may be a good option for treating osteoporotic thoracolumbar fractures, as it can prevent recurrent vertebral fractures or related kyphosis in sagittal alignment.
Highlights
Owing to the increasing size of the aging population worldwide, osteoporosis and its associated fractures have become an important health issue
After PVP or percutaneous kyphoplasty (PKP), recurrent vertebral compression fractures (VCFs) at the index level have been reported, which are accompanied by progressive kyphosis
Our findings show that cortical bone trajectory (CBT) screws were well tolerated in all patients, yielded good patient outcomes, findings show that CBT
Summary
Owing to the increasing size of the aging population worldwide, osteoporosis and its associated fractures have become an important health issue. After PVP or PKP, recurrent VCFs at the index level have been reported, which are accompanied by progressive kyphosis. Gu et al [7,8] proposed the use of minimally invasive short-segment pedicle screw fixation combined with PVP or PKP to stabilize the fractured spine and prevent recurrent VCFs. older osteoporotic patients treated using pedicle screws experience higher rates of complications than do younger populations, including instrument loosening, pullout, and migration [9]. The usefulness of CBT screws in PVP for older patients with osteoporotic thoracolumbar VCFs remains unclear. We assess the effectiveness of using short-segment CBT screw fixation with PVP in 12 patients with osteoporotic thoracolumbar VCFs in terms of patient outcomes, complications, and instrument failure. All patients achieved adequate pain relief and no patient experienced recurrent compression fractures or progressive kyphosis for at least 24 months following the procedure
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