Pedicle screw fixation after vertebroplasty augmentation for osteoporotic thoracolumbar burst frac-tures

Abstract

Objective To evaluate the curative effects of pedicle screw fixation after vertebroplasty augmentation using polymethylmethacrylate (PMMA) for osteoporotic thoracolumbar burst fractures in com-parison with traditional pedicle screw fixation. Methods From January 2007 to August 2013, 25 patients with osteoporotic thoracolumbar burst fracture underwent pedicle screw fixation after vertebroplasty augmenta-tion using PMMA (augmentation group) and 32 patients with the same disorder underwent pedicle screw fix-ation directly (direct group). The two groups were compared in terms of perioperative indexes, visual analogue scale (VAS), Oswestry disability index (ODI), complications, cobb angle of the fixed segment, loss of vertebral body height, and spinal canal encroachment. Results These patients were followed up for an average of 37.5 months. Compared with the direct group, the augmentation group had significantly more pe-rioperative bleeding, shorter hospitalization, shorter time for pain relief and shorter time for ambulatory re-covery (P<0.05). The VAS, ODI, cobb angle of the fixed segment and loss of vertebral body height at 7-day, 3-, 6-, 12-, and 24-month were significantly improved in all the patients (P<0.05). The aug-mentation group had significantly better improvements in VAS, ODI, cobb angle of the fixed segment and loss of vertebral body height at 7-day, 3-, 6-, 12-, 24-,and 36-month than the direct group (P<0.05). None of the patients had complications of neural injury, pulmonary thrombosis or poor wound healing. Five patients in the direct group had to receive a second operation to remove the instrumentation due to pedicle screw loosening and back pain. Conclusions In the treatment of osteoporotic thoracolumbar burst fractures, pedicle screw fix-ation after vertebroplasty augmentation using PMMA can lead to less pain, quicker and better recovery, better fracture reduction and kyphosis correction, and less loss correction than traditional open pedicle screw fixation. Key words: Spinal fractures; Osteoporosis; Vertebroplasty; Cement; Polymethyl-methacrylate