Efficacy comparison of percutaneous pedicle instrumentation combined with vertebral fracture fixation or vertebral augmentation for treatment of osteoporotic thoracolumbar fractures in elderly patients

Abstract

Objective To compare the outcomes of percutaneous pedicle instrumentation combined with vertebral augmentation or vertebra pedicle instrumentation for treatment of osteoporotic thoracolumbar fractures (OVCF) in elderly patients. Methods A retrospective case cohort study was conducted on 62 patients with OVCF manifesting non-neurological symptoms treated from January 2009 to January 2012. There were 22 males and 30 females, with a mean age of 61.3 years (range, 55 to 70 years). Fracture level was T11 in 8 patients, T12in 20, L1 in 22 and L2 in 12. Treatments included percutaneous pedicle instrumentation combined with vertebral fracture fixation in 36 patients (Group A) and percutaneous pedicle instrumentation combined with vertebral augmentation in 26 patients (Group B). Operation time, intraoperative blood loss, anterior vertebral body height, sagittal Cobb angle and visual analogue score (VAS) were compared between the two groups. Results All patients were followed up for average 46.5 months (range, 36 to 58 months). Operation time in Group A [(82.6±16.2)min] was shorter than that in Group B [(96.8±20.6) min] (P 0.05). At the final follow-up, the ratio of anterior vertebral height and Cobb angle in Group B [(87.8±2.5)%, (7.8±3.5)°] were better than these in Group A [(82.6±3.2)%, (9.1±1.8)°] (P 0.05). Bone cement leakage was seen in four patients in Group B. During the perioperative period, there were 3 patients with lung infection in Group A and 1 patient with lower limb deep vein thrombosis in Group B. No implant failure occurred in both groups. Conclusion Both procedures are effective in treating elderly patients with OVCF, but percutaneous pedicle instrumentation combined with vertebral augmentation is associated with better results in maintaining vertebral height and preventing kyphosis. Key words: Osteoporotic fractures; Spinal fractures; Fracture fixation, internal