Thoracolumbar Compression Fractures Research Articles

Comparison of short-time clinical efficacy of percutaneous and open pedicle screw fixation for type A1-A3 thoracolumbar fractures

Objective To investigate the clinical efficacy of short segment fixation with percutaneous pedicle screws or traditional open surgery for the type A1-A3 thoracolumbar compression fracture. Methods A retrospective case control study was conducted on the clinical data of 64 patients with thoracolumbar compression fracture admitted to Shanxi Dayi Hospital between January 2012 and February 2017. There were 44 males and 20 females, aged 21-65 years [(45.4±11.1)years]. There was one patient with injured segment at T11, 29 at T12, 27 at L1 and seven at L2. According to AO typing, there were 39 patients classified as Type A1, two as Type A2 and 23 as Type A3. The patients were divided into minimally invasive surgery group (n=37) and open surgery group (n=27). Minimally invasive surgery group was treated with minimally invasive percutaneous pedicle screw fixation and open reduction. The open surgery group was treated with traditional open pedicle screw short segment fixation and open reduction. The operation time, intraoperative blood loss, total hospitalization time, postoperative hospitalization time, visual analogue scale (VAS) before and after operation, local kyphosis of the fractured vertebra, segmental kyphosis and complications in two groups were recorded. Results All patients were followed up for 12-29 months, with an average of 13.2 months. Between the minimally invasive surgery group and open surgery group, no significant difference was found in the operation time [(106.4±37.3)minutes vs.(131.3±33.6)minutes](P>0.05), and significant differences were found in intraoperative blood loss [(71.2±34.9)ml vs.(409.3±267.5)ml], total hospitalization time [(11.7±7.2)days vs. (21.6±12.8)days] and postoperative hospitalization time [(8.1±7.4)days vs. (16.6±10.6)days] (P 0.05), but significant difference was found in VAS immediately after operation between the two groups (P 0.05). In the minimally invasive surgery group, the segmental kyphosis Cobb angle was (16.1±9.1)° before operation, (3.0±1.8)° immediately after operation, and (5.9±1.8)° at final follow-up. In the open surgery group, the segmental kyphosis Cobb angle was (15.2±12.0)° before operation, (3.1±1.4)° immediately after operation, and (5.6±2.1)° at final follow-up. The segmental kyphosis Cobb angle immediately after operation and at final follow-up were significantly decreased within the two groups compared with the preoperative Cobb angle (P 0.05). No spinal cord injuries because of pedicle screws were observed after operation in either group. In the open surgery group, there was one patient with wound infection who recovered after dressing change, and no infection case was found in the minimally invasive surgery group. Conclusion For type A1-A3 thoracolumbar compression fractures, both the minimally invasive posterior pedicle screw fixation and the traditional open pedicle screw fixation can achieve satisfactory near-term results, and the former is better in intraoperative blood loss, immediate relief of pain after operation and shorter hospital stay than the latter. Key words: Spinal fractures; Fracture fixation, internal; Pedicle screws

흉추 및 요추 압박골절 환자의 통증 감소에 대한 한의학적 치료 효과 : 후향적 관찰연구

The aim of the study was to investigate the effect of Korean medicine treatments on pain reduction of thoracolumbar compression fracture patients. We analysed 48 patients who have been diagnosed as thoracolumbar compression fracture on Computed Tomography(CT) or Magnetic Resonance Imaging(MRI) scan and had admitted to Dunsan Korean Medical hospital from January 1,2014 to April 4, 2017. The analysis was conducted as retrospective study which analyzes patient

Dual-Energy Computed Tomography-Based Display of Bone Marrow Edema in Incidental Vertebral Compression Fractures: Diagnostic Accuracy and Characterization in Oncological Patients Undergoing Routine Staging Computed Tomography.

The aim of this study was to evaluate the diagnostic performance of virtual noncalcium (VNCa) dual-energy computed tomography (DECT) reconstructions enabling visualization of bone marrow edema for characterization of incidental thoracolumbar compression fractures in routine thoracoabdominal staging computed tomography (CT). We retrospectively analyzed 51 oncological patients without suspected fracture or indicative complaints presenting at least 1 thoracolumbar compression fracture on routine thoracoabdominal staging DECT who had been examined between October 2015 and June 2017 using third-generation dual-source CT, had a previous CT within 3 months before, and also had undergone additional magnetic resonance imaging within 14 days, which served as the standard of reference. Three independent and blinded radiologists initially evaluated all vertebrae on conventional grayscale DECT series; after at least 8 weeks, observers reevaluated all cases using grayscale and color-coded VNCa DECT images. The age of each fracture was determined as either acute, chronic, or inconclusive. Specificity, sensitivity, and intraobserver and interobserver agreements were calculated taking into account clustering. A total of 98 vertebral compression fractures were detected in 51 patients (20 women, 31 men; median of 1 fracture per patient). The reference standard defined 45 as acute and 53 as chronic. For identification of only acute fractures (cutoff 1), the combination of grayscale and VNCa image series showed a higher sensitivity (91% vs 47%; P < 0.001) but equal specificity (both 100%) compared with analysis of grayscale images alone. When defining a positive finding as a fracture considered either acute or inconclusive (cutoff 2), combined analysis of grayscale and VNCa images showed similar sensitivity (96% vs 93%; P = 0.28) but significantly higher specificity (96% vs 75%; P < 0.001) compared with evaluation of grayscale images alone. Area under the curve analysis for detection of vertebral compression fractures showed superior results for reading of grayscale and VNCa image series (0.98) compared with analysis of grayscale images alone (0.89; P < 0.001). Dual-energy CT-derived color-coded VNCa reconstructions substantially improve the characterization of incidental thoracolumbar compression fractures seen on routine thoracoabdominal staging DECT by allowing for visualization of bone marrow edema.

A Feasibility Study of Acupuncture for Chronic Pain in Patients with Osteoporotic Thoracolumbar Compression Fracture: A Prospective Case Series

A Feasibility Study of Acupuncture for Chronic Pain in Patients with Osteoporotic Thoracolumbar Compression Fracture: A Prospective Case Series

Percutaneous balloon kyphoplasty, a good minimally invasive surgical option for osteoporotic thoracolumbar compression fracture

The aim of this study is to evaluate balloon kyphoplasty as a surgical option for osteoporotic thoracolumbar compression fracture. The study was conducted on 30 patients from January 2014 to December 2017. The anterior vertebral height, kyphotic angle and functional evaluation by Oswestry disability index (ODI) and visual analogue scale (VAS) score were recorded preoperatively, immediate post-operatively at 3, 6, 12 months and yearly then on. All patients showed improvement in mean kyphotic angle from 16.4 ± 3.5 to 5.6 ± 1.7 post-operatively and 8.4 ± 1.6 at final follow-up. There was significant increase in mean anterior vertebral height from 51 ± 7.3% before surgery to 75.5 ± 7.4% at one day after surgery and 71.2 ± 3.2% at the last follow-up. There was significant improvement in mean VAS score from 8.1 ± 0.9 before surgery to 2.2 ± 0.4 at one day, and 2.4 ± 0.3 at final follow-up. The improvement in patients’ ODI score after surgery from 71.4 ± 3.4 to 26.0 ± 4.8 at one day and 21.2 ± 5.5 at final follow-up was noted. The mean operating time was 45.5 ± 15.5 min for each vertebra. Within first day of surgery improvement in pain relief and mobility was experienced by all patients. The orthopedic balloon ruptured in one patient and it was replaced then procedure was continued with no complications. There were no neurological complications in all cases and there was no infections and any occurrence of symptomatic pulmonary embolism. In conclusion, balloon kyphoplasty is a good minimally invasive procedure where along with reduction of pain and disability there is also restoration of sagittal alignment post-operatively.

Therapeutic influence of using intermediate screws or not in short segment navigated percutaneous pedicular screws fixation for thoracolumbar compression fracture

Objective To investigate the therapeutic influence of short segment fixation with navigated percutaneous pedicle screws in the treatment of thoracolumbar compression fracture and whether use of pedicle screw fixation affects the treatment efficacy. Methods A retrospective case control study was conducted on the clinical data of 38 patients with thoracolumbar compression fracture admitted between January 2014 and October 2016. There were 27 males and 11 females, with an average age of 35.9 years (range, 21-59 years). There were 14 cases with injured segment at T12, 14 cases at L1, and 10 cases at L2, all of which were classified as Type A according to AO typing. The patients were divided into screw group (n=22) and non-screw group (n=16). The pedicle screws were placed into the upper and lower adjacent segments of the fracture vertebra or the fracture vertebra by percutaneous fluoroscopy-guided navigation. The operation time, intraoperative blood loss, Visual analogue scale (VAS) before and after operation, anterior vertebral body height, Cobb angle, and complications in two groups were recorded. Results All patients were followed up for 12-30 months, average 15.2 months. No significant differences were found between the screw group and the non-screw group with respect to operation time [(44.7±12.6)minutes vs. (39.3±11.9)minutes] and blood loss [(56.8±13)ml vs. (48.4±11.0)ml](P>0.05). In the screw group, preoperative VAS was (6.7±1.5) points, and VAS at postoperative 1 week, six months and 1 year were (2.3±0.9) points, (1.1±0.3) points and (0.9±0.5)points, respectively (P 0.05). In the screw group, anterior vertebral body height was (59. 5±13.6)% preoperatively, and anterior vertebral body height at postoperative 1 week, six months and 1 year was (90.6±7.7)%, (89.3±8.3)% and (88.4±7.9)% (P 0.05). In the screw group, preoperative Cobb angle was (15.6±4.1)° , and Cobb angle at postoperative 1 week, six months and 1 year was (3.0±1.8)°, (5.0±1.9)° and (5.9±1.8)°, respectively (P 0.05). No spinal cord injuries because of pedicle screws were observed after operation in both groups. Conclusions For thoracolumbar compression fracture, short segment fixation with navigated percutaneous pedicle screws has the advantages of shorter operation time, less bleeding, better postoperative pain relief, and fewer complications. In addition, the postoperative VAS, anterior vertebral body height and sagittal Cobb angle are improved significantly. However, use of pedicle screw fixation in fracture vertebra does not have significant influence on the treatment efficacy. Key words: Spinal fractures; Fracture fixation, internal; Pedicle screws

Protection of Paravertebral Muscles and Short Segment Stabilization in Surgical Treatment of Thoracic and Lumbar Compression Fractures

Objective: In this study, patients with thoracolumbar and lumbar fracture fractures were treated with preservation of the paravertebral muscles, unfused posterior short-segment pedicle instrumentation technique. Methods: Between the years 2009-2015, 24 patients were applied short-segment posterior instrumentation surgery for thoracolumbar and lumbar compression fractures in our clinic included in the study. On radiological evaluation, loss of height in spinal anterior corpus (LHSAC) and local angle of kyphosis (LAK) were used. In the operation, the thoracolumbar fascia opened linearly, fascia was excised laterally and finger-dislocated between the multifidus and longissimus muscles. The transversal processes of vertebrates and manufactured objects were found. The transpedicular screws were placed with the C-arm. Results: The mean local angle of kyphosis measured preoperatively was 11.03 degrees and this angle 7.24 degrees at the end of the first year. Before the operation, loss of height in the spinal anterior corpus (LHSAC) was determined as 27.21% on average. At the end of the 1st year, the mean LHSAC was measured as 22.83%. Mean duration of the operation was 103.75 min and mean blood loss was 123.12 ml. Conclusion: In this surgical procedure, preservation of the paravertebral muscles contributes to vertebral column stabilization in cases of short segment instrumentation. For this reason, short segment instrumentation in thoracic and lumbar locations provides a significant kyphotic improvement in patients with compression fractures.

Clinical outcome of bone cement-augmented pedicle screw fixation for thoracolumbar refractures after percutaneous kyphoplasty

Objective To investigate the clinical therapeutic effects of bone cement-augmented pedicle screw fixation for cement vertebrae refractures with lower limb neurological symptoms after percutaneous kyphoplasty (PKP) in elderly patients with osteoporotic thoracolumbar compression fractures. Methods A total of 123 elderly patients with osteoporotic thoracolumbar compression fractures underwent PKP from December 2013 to December 2016 were retrospectively analyzed by case series study. Twelve patients had vertebral refracture with compression of the spinal cord or cauda equina which resulted in lumbosacral and leg pain, numbness and disability of ambulation and there were five males and seven females, with age of (69.2±7.1)years. Injured vertebrae was located at T12in five cases, at L1 in five and at L2 in two. Bone cement-augmented pedicle screw fixation through a standard posterior approach was utilized to treat all the 12 patients. Visual analogue scale (VAS), Oswestry disability index (ODI), anterior vertebral height compression ratio, and kyphotic angle at the preoperative time, one week postoperatively and last follow-up were recorded and compared. Intraoperative and postope-rative complications were also recorded. Results The mean duration of follow-up in all the patients was 26.7 months (range, 12-36 months). Intraoperative nerve injury, dural tear, leakage of bone cement, bone cement toxicity reaction, and pulmonary embolism were not observed during the surgery. The postoperative radiographs for all the 12 patients showed that the bone cement was distributed in cancellous bone and around the screw appropriately where there was no cement leakage out of the vertebral body or pedicle. Compared with preoperative scores, the average low back pain VAS, leg pain VAS and ODI at postoperative one week were improved by (2.2±0.7)points, (2.2±0.4)points and (33.2±8.9)points, respectively (P 0.05). Conclusion For elderly patients with spinal cord or cauda equina nerve compression symptoms after PKP for osteoporotic thoracolumbar compression fractures, the usage of posterior approach bone cement-augmented pedicle screw fixation can effectively correct kyphosis, relieve neurological symptoms and restore spinal stability. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Internal fixators; Vertebral refracture

87 - A New Treatment Approach for Type A Thoracolumbar Compression Fractures with Minimum 4-Year Follow-Up

BACKGROUND CONTEXT: In the treatment of type A thoracolumbar compression fractures, posterior pedicle screws instrumentation approach is considered an appropriate surgical choice. The new technique simplifies and optimizes the previous surgical treatment because it eliminates the need for pedicle screws.

Feasibility and curative effect of percutaneous vertebroplasty with flexible bone cement injector

Objective To evaluate the clinical efficacy of percutaneous vertebroplasty (PVP) with flexible bone cement injector through unilateral puncture. Method Unilateral puncture line PVP treatment for thoracolumbar vertebral compression fracture was conducted in 78 patients, which was divided into observation group and control group according to the use of different equipment. The flexible bone cement injector was used in 36 cases of observation group, which injected the bone cement into three places at the vertebral body. The ordinary straight bone cement injector was applied in the 42 cases of the control group. The operation time, the time of radiation exposure, and the amount of bone cement injection were recorded, and the leakage of bone cement was observed. The visual analogue scale (VAS), relative vertebral height and Cobb angle were recorded at 1 week, 1 and 2 years follow-up. The time of operation, the time of radiation exposure, the amount of bone cement injection, the incidence of bone cement leakage, VAS, relative height of vertebral body and Cobb angle were compared between the two groups using independent samples t test or χ2 test. Result All patients in the two groups were successfully treated by surgery. There were no significant differences between the observation group and the control group in the operation time and the time of radiation exposure and the incidence of bone cement leakage (P>0.05). The injection amounts of bone cement in the observation group and the control group were (5.6±0.7) and (3.2±0.6) ml, with statistically significant difference (P 0.05). At 1 year and 2 years after operation, the differences of the above indexes between the two groups were significantly different (P<0.05), with the observation group being superior to the control group. Conclusions Application of flexible bone cement injector for PVP operation is safe and feasible. Compared with the traditional straight bone cement injector, the use of flexible bone cement injector will not increase the operation time, radiation exposure time and the incidence of bone cement leakage but will improve the long-term effect. Key words: Spinal fractures; Vertebroplasty; Complications

The study of T1 pelvic angle and spino-pelvic sagittal balance in thoracolumbar osteoporotic vertebral compression fractures

Objective To investigate the value of T1 pelvic angle (TPA) in the evalution of spino-pelvic sagittal balance through studying thoracolumbar osteoporotic vertebral compression fractures (OVCFs). Methods This was an analysis of 120 cases with thoracolumbar OVCFs, Sagittal parameters of sagittal vertical axis (SVA), T1 pelvic angle (TPA), thoracic kyphosis (TK), thoraco-lumbar kyphosis (TLK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), the Oswestry disability index (ODI) were measured. The cases were divided into balance group and imbalance group according to the judgment standard of the spinal sagittal balance. The multiple-level vertebral fractures were analyzed in each group. The sagittal parameters of the two groups were analyzed. Results (1) The multiple-level vertebral fractures were found in 67.92% of the imbalance group and 37.13%of the balance group. (2) No difference in PI was found among the two groups (P=0.325), TLK, SVA, TPA, PT, ODI in the imbalance group were bigger than those in the balance group, however, LL, SS was smaller (P=0.000). (3) In the imbalance group, TPA was correlated with SVA, LL, PI, PT, SS, ODI (P=0.000), In the balance group, SVA was correlated with TPA, TK, TLK, LL, PT, ODI, TPA was correlated with TK, TLK, LL, PI, PT, SS, ODI, the balance group tend to present sagittal compensation, meanwhile the imbalance group demonstrated sagittal decompensation with anterior-shifted SVA. Conclusion TPA can both represent the sagittal balance of spine and pelvis. Key words: T1 pelvic angle; Osteoporosis; Vertebral compression fracture; Sagittal balance

Surgical treatment of osteoporotic thoraco-lumbar compressive fractures: the use of pedicle screw with augmentation PMMA.

The osteoporosis prevalence in population is age related. The aim of this single-center observational study was evaluate the middle- to long-term performance of cement (PMMA) augmented fenestrated pedicle screws in elderly patients with thoraco-lumbar compressive fractures by osteoporosis. From 2011 to 2015 we treated 52 patients (20 males and 32 females) suffering from somatic osteoporotic fractures (T10-L2). The average age was 73.4years, with an age range between 65 and 82years. The treatment consisted of stabilization with pedicle screw augmentation with PMMA cement. Patients were clinically evaluated with Visual Analyzing System scale (VAS scale) and with low back disability questionnaire Oswestry, in pre and post surgery and during the follow up at 12 and 24months. A total of 410 fenestrated pedicle screws with PMMA augmentation were implanted. No cases of loosening or pulling out of screws were recorded. There have been n 3 cases of thrombophlebitis, treated with oral anticoagulant drugs and 1 case of post-operative death due to ventricular fibrillation. No neurological complications occurred during the study. The mean VAS score decreased from 8.5 to 4.8 and the result remained stable during follow up. Oswestry questionnaire showed a mean decrease of low back pain of 24% in post-op period. Fenestrated screws with PMMA augmentation offers a possibility to treat patients with reduced bone quality due to severe osteoporosis.

Mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation for old thoracolumbar compression fractures with kyphosis deformity

Objective To analyze the clinical results of mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation for old thoracolumbar compression fractures combined with kyphosis deformity. Methods A retrospective case series study was made on 14 patients with old thoracolumbar compression fractures combined with thoracolumbar kyphosis undergone mini-incision Schwab grade 4 osteotomy plus percutaneous pedicle screw fixation from January 2014 to May 2015. There were 5 males and 9 females, with mean age of 64.5 years (range, 58-70 years). The period between injury and surgery ranged between 6 and 14 months (mean, 8.6 months). At the time of surgery, the fracture was already healed in 10 patients, while non-healing was found in other 4 patients. Preoperative visual analogue score (VAS) of back pain was (8.5±1.1)points (range, 6.5-10 points). Three patients were associated with neurological dysfunction [American Spinal Injury Association (ASIA) grade D]. Apex of kyphosis located at T12 in 6 patients and at L1 in 8 patients. Preoperative kyphosis Cobb angle was (42.5±6.0)°(range, 39.5°-47.2°). Operation time, blood loss, perioperative complications, postoperative kyphosis Cobb angle, bone fusion, state of implants, neurological function and VAS were determined. Results Operation time was (280±50)min, and blood loss was (110±70)ml. No segmental vessels injury, neurological deficit or dural disruption occurred during the surgery and after surgery. Compared to the preoperative detection, kyphosis Cobb angle was improved to (9.3±1.7)°(range, 6.2°-12.1°) after operation(P<0.05), with the correction rate of 78.1%. Post-operative CT showed 7 screws (6.3%, 7/112) were grade 1 screws. The follow-up was lasted for mean 25.2 months (range, 14-28.9 months). At the latest follow-up, the kyphosis Cobb angle was (9.6±4.1)°(range, 6.0°-13.1°), revealing no correction loss. Interbody bone fusion was good, with no instrumentation-related complications observed. Three patients with neurological dysfunction (ASIA grade D) were recovered to ASIA grade E. Compared to the preoperative detection, back pain was improved with the VAS of (2.6±1.0) points at the latest follow-up (P<0.05). Conclusion Mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation of old thoracolumbar compression fractures with kyphosis deformity can attain satisfactory and reliable efficacy and bone fusion, with low incidence of complications. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Kyphosis

Transpedicular screw fixation plus percutaneous vertebroplasty for treatment of severe thoracolumbar osteoporotic vertebral compression fractures

Objective To investigate the curative effect of transpedicular screw fixation plus percutaneous vertebroplasty (PVP) for treatment of severe thoracolumbar osteoporotic vertebral compression fractures (OVCF). Methods Twenty-one patients with severe OVCF presenting to our hospital from July 2012 to May 2015 were analyzed retrospectively. There were nine male and twelve female patients, aged 50-78 years (mean, 68.8 years). The level of injury was T11 in four patients, T12 in six, L1 in five, L2 in three, L3 in two and L4 in one. Time between injury and surgery was 2-16 d (mean, 7.5 d). All patients underwent pedicle screw fixation at the injured level combined with PVP. Visual analogue scale (VAS) was used for evaluation of lower back pain after operation, Oswestry disability index(ODI) for lower back function, lateral thoracolumbar film for Cobb angle and anterior vertebral height compression ratio, and American Spinal Injury Association (ASIA) score for spinal cord nerve function. Postoperative complications were recorded. Results All patients were followed up for 12-21 months [(15.7±2.9)months]. Postoperative studies showed significant differences in VAS[ (2.9±1.1)scores], ODI [(30.8±7.5)% ], Cobb angle [ (21.5±7.3)°] and anterior vertebral height compression ratio [(44.3±13.9)%] compared to the preoperative measures (P 0.05). According to the ASIA score, eight patients with neural function injury had one to two level recovery at the final follow-up. Asymptomatic cement leakage occurred in seven patients after operation. There was no internal fixation breakage at the final follow-up. Conclusions Transpedicular screw fixation plus PVP can not only restore the height and strength of the injured vertebrae and correct kyphotic deformity, but also relieve low back pain and improve function of the spine. Therefore, the technique is a safe, reliable and effective surgical treatment for severe thoracolumbar OVCF. Key words: Osteoporotic fractures; Vertebroplasty; Pedicle screw fixation

Changing threshold for AIS scores of thoracolumbar compression fractures

ABSTRACTBackground: The Abbreviated Injury Scale (AIS) is an anatomical-based coding system created by the Association for the Advancement of Automotive Medicine, utilized to classify and code injuries resulting from trauma, in order of severity. According to the latest version, all Thoraco-Lumbar Compression Fractures (TLCF), even without injury to other spine components and with >20% loss of height, were branded AIS 3 injuries, reflecting a serious threat to life or permanent disability. Advances in spine imaging, recent biomechanical studies, and long-term outcomes research offer the opportunity to consider these injuries differently.Objective: To re-evaluate the percent compression threshold of TLCF of the spine from motor vehicle crashes (MVC) for serious risk to life identified as surgical treatment, delineating a reliable cut-off for fracture severity and morbidity. Little national data considers degree of compression and provides adequate followup imaging to determine degree of compression, justifying this effort.Methods: Charts and radiographs of patients admitted to our institution due to vehicle crashes with isolated (vertebral body only) TLCF between 2008 and 2015 were reviewed. Data were collected on degree of compression, treatment, and long-term outcomes to determine the threshold of permanent injury. Vertebral bodies at the level of fracture were measured both anteriorly and posteriorly, and compared to adjacent segments; percentage compression was calculated.Results: 1470 patient records with diagnoses of spine trauma were reviewed; 695 isolated compression fractures were identified, of which 194 were in vehicle crashes and had adequate imaging and follow-up. Ages ranged from 19 to 82, with a male: female ratio of 60:40. No patient with vertebral body compression of less than 30% underwent surgery unless presenting with a neurological deficit. All 22 surgical patients demonstrated significant retropulsion of bone into the spinal canal. Five surgical patients suffered eight complications; there were no adverse outcomes in the nonsurgical group.Conclusions: These results are consistent with evolving clinical thinking, resulting in decreasing surgical incidence and orthosis use. Our data strongly suggests that isolated compression fractures in the absence of neurologic deficit or severe cord compression due to retropulsed bone are self-limiting. Therefore, the AIS scores for these common injuries could be reconsidered and reflect their relatively benign outlook.

Research progress in kyphoplasty and vertebroplasty for treatment of thoracolumbar osteoporotic compression fracture

Research progress in kyphoplasty and vertebroplasty for treatment of thoracolumbar osteoporotic compression fracture

維持血液透析患者に対して経皮的椎体形成術を施行した4症例についての検討

維持血液透析患者に対して経皮的椎体形成術を施行した4症例についての検討

Percutaneous Pedicle Screw Fixation with Polymethylmethacrylate Augmentation for the Treatment of Thoracolumbar Intravertebral Pseudoarthrosis Associated with Kummell’s Osteonecrosis

Purpose. The purpose of our study is to evaluate the therapeutic efficacy of short-segment percutaneous pedicle screw fixation with polymethylmethacrylate (PMMA) augmentation for the treatment of osteoporotic thoracolumbar compression fracture with osteonecrosis. Methods. Osteoporotic thoracolumbar compression fractures with avascular necrosis were treated by short-segment PPF with PMMA augmentation. Eighteen were followed up for more than 2 years. The kyphotic angle, compression ratio, visual analog scale (VAS) score for back pain, and the Oswestry Disability Index (ODI) were analyzed. In addition, radiologic and clinical parameters of PPF group were compared with percutaneous vertebroplasty (PVP) group. Results. Vertebral height and kyphotic angle of the compressed vertebral bodies were significantly corrected after the operation (P < 0.05). Further, restored vertebral height was maintained during the 2 or more years of postoperative follow-up. Compared to the PVP group the postoperative compression ratio and kyphotic angle were significantly lower in the PPF group (P < 0.05). The postoperative ODI and VAS of the PVP group were significantly higher than the PPF (P < 0.05). Conclusions. According to our results, short-segment PPF with PMMA augmentation may be an effective minimally invasive treatment for osteoporosis in cases of osteoporotic vertebral compression fractures with Kummell's osteonecrosis.

The effect of targeted psychological intervention in the painless suspension restoration treatment for the patients with thoracolumbar vertebral compression fractures before operation

Objective To observe the effect of targeted psychological intervention in the painless suspension restoration treatment for the patients with thoracolumbar vertebral compression fractures before operation. Methods A total of 100 cases of thoracolumbar vertebral compression fracture were randomly divided into intervention group and control group with 50 cases in each group, all patients underwent preoperative preparation and operation according to the conventional intervention group, nursing staff to give targeted psychological intervention according to the individual condition of patients. The 2 groups of patients before operation and immediately and 10~15 min of the heart rate, blood pressure values were compared. And the self-rating anxiety scale (SAS) was used. Results Two groups of the operation, 10~15 min intervention, anxiety level in patients with blood pressure, heart rate was significantly lower than that of the control group. Conclusions Preoperative psychological intervention can effectively reduce the thoracic and lumbar vertebral compression fracture patients undergoing painless suspension reduction treatment of anxiety, improve the success rate of operation, and can promote the rehabilitation of patients. Key words: Psychological intervention; Anesthesia analgesia; Supine suspension restoration; Thoracolumbar vertebral compression fractures

Clinical and radiological outcomes of conservative treatment after stable post-traumatic thoracolumbar fractures in elderly: Is it really best option for all elderly patients?

ObjectiveThe purpose of this study was to research the effectiveness of conservative treatment of stable post-traumatic thoracolumbar vertebral fractures in elderly patients.MethodsThe study included 21 elderly patients (13 females, 8 males) with post-traumatic thoracolumbar compression fracture who were treated with a brace. Fractures without any trauma history, pathological fractures, patients younger than 60 years old and patients with no malignancy history were excluded from study. Neurological examination and posterior ligamentous complex (PLC) were intact in all patients. Radiological parameters and pain scores were recorded in regular follow-up.ResultsThe mean age and follow-up were 71.3 years (range, 60–84 years) and 20.1 months (range, 12–26 months) respectively. During follow-up, 4 patients had significant height loss resulting in kyphotic deformity and intractable pain. There was a significant increase in the local kyphosis angle (p = 0.001) and height loss percentage (p = 0.017). At the final follow-up, the mean Denis Score of pain was 1.62 ± 0.74.ConclusionAlthough there is wide acceptance of conservative treatment of post-traumatic stable thoracolumbar fracture with intact PCL according to the Thoracolumbar Injury Classification and Severity Score (TLICS), elderly female patients with a post-traumatic compression fracture in the junctional region are at great risk of conservative treatment failure. These patients should be well-informed about the possible complications and poor results of conservative treatment, and surgical treatment should be considered in selective cases with the informed consent of the patients.