Efficacy comparison of pedicle screw with vertebroplasty or intermediate screw for osteoporotic thoracolumbar compression fractures

Abstract

Objective To compare the efficacy of pedicle screw with vertebroplasty (PSV) or intermediate screw (PSIS) for osteoporotic thoracolumbar compression fractures. Methods A retrospective case control study was conducted to analyze the clinical data of 141 patients with osteoporotic thoracolumbar vertebral compression fractures admitted to Honghui Hospital, College of Medicine, Xi'an Jiaotong University from January 1, 2012 to December 31, 2015. There were 59 males and 82 females, aged 60-75 years, with an average age of 65.4 years. All the fractures had bone mineral density (BMD) T value 15 degrees or anterior column compression > 40%. There were 65 patients with thoracic vertebral fractures (T10-T12) and 76 with lumbar vertebral fractures (L1-L4). Among all patients, 68 received PSV treatment (PSV group) and 73 received fixed PSIS treatment (PSIS group). The operation time, intraoperative blood loss, visual analogue scale (VAS), anterior height ratio, central height ratio, and segmental kyphosis angle at 3 days, 3 months, 6 months, 1 year and 2 years after operation were compared between the two groups. The complications were recorded. Results All patients were followed up for 25-31 months, with an average of 27.9 months. There were no significant differences in operation time and intraoperative blood loss between the two groups (P>0.05). VAS at each time point of postoperative follow-up was significantly lower than those before operation in both groups (P 0.05). Anterior height ratios of PSV group were higher than those of PSIP group at postoperative 3 months, 6 months, 1 year and 2 years (P<0.05) [(95.2±5.2) vs. (92.6±7.1), (93.8±5.2) vs. (91.4±3.2), (93.3±4.9) vs. (91.2±5.1), (92.6±5.5) vs. (90.1±4.7)]. The central height ratios of PSV group were higher than those of PSIP group at postoperative 6 months, 1 year and 2 years [(91.4 ±6.9) vs. (88.9±7.2), (90.8±7.4) vs. (88.4±5.9), (90.1±7.6) vs. (87.1±7.2)](P<0.05). Segmental kyphosis angle of PSV group was lower than that of PSIP group at postoperative 3 months, 6 months, 1 year and 2 years [(2.9±0.4)° vs. (3.2±0.9)°, (3.0±0.5)° vs. (3.2±0.3)°, (3.1±0.7)° vs. (3.4±0.4)°, (3.1±0.4)° vs. (3.4±0.7)°](P<0.05 or 0.01). Bone cement leakage from screws occurred in two patients in PSV group and three patients in PSIS group. Cement leakage occurred in the injured vertebra in four patients of PSV group, with no any symptom. In PSIS group, two patients suffered from one side rod breakage at 9 months and 1 year after surgery, respectively. CT showed sound bone healing, without any further management. Conclusion For osteoporotic thoracolumbar compression fractures, PSV can attain similar pain relief compared with PSIS, but the former is more conducive to reducing the loss of anterior and middle column height and correcting kyphosis deformity. Key words: Osteoporotic fractures; Spinal fractures; Bone cement