Treatment Of Thoracolumbar Compression Fractures Research Articles

A Novel Leverage Technique Using Monoaxial Pedicle Screw for Reduction of Thoracolumbar Compression Fractures: Surgical Technique and Analysis of Radiological Parameters.

Thoracolumbar compression fractures resulting from high-energy injuries are a common type of spinal fracture. Satisfying reduction of compressive vertebra body is essential for the clinical outcome. However, traditional distraction technique may lead to complications including pedicle screw loosening, pedicle screw breakage, and postoperative back pain because of excessive distraction. In this study, we reported a novel technique for reduction. Additionally, the effect and postoperative radiological parameters of this technique were compared with those of traditional distraction technique. The clinical data of 80 patients who had been treated with posterior pedicle screw fixation from January 2019 to December 2020 was retrospectively analyzed. Thirty-six patients were performed with the leverage technique, while 22 patients were treated with the traditional distraction technique. When pedicle screw fixation was performed with either the leverage technique or the traditional distraction technique, fracture reduction was completed with monoaxial pedicle screws using either the leverage maneuver or distraction of adjacent vertebrae. Clinical evaluation, including operation time, hospital stay, blood loss volume, and postoperative complications were collected. The American Spinal Injury Association (ASIA) score for neurological condition and the visual analog scale (VAS) score for pain were used to evaluate the patients' functional outcome. The radiographic analysis included local kyphotic angle (LKA), regional kyphotic angle (RKA), anterior vertebral height (AVH), posterior vertebral height (PVH), and sagittal compression (SC). The student t-test and the χ2-test (or the Fisher exact test) were used to compare the outcome measures between the two groups. The leverage group comprised 36 patients, while 44 patients were included in the distraction group. No statistically significant differences were found in the demographic data. The VAS score in the leverage group (3.0 ± 0.8) was significantly lower than that in the distraction group (4.2 ± 0.6) on postoperative day 1. Total correction of the LKA in the leverage group (11.5 ± 2.5°) was significantly higher than that in the distraction group (7.1 ± 1.3°) (p = 0.0004). Total correction of the RKA was higher in the leverage group (12.1 ± 4.3°) than in the distraction group (6.1 ± 0.9°) (p = 0.005). The ratio of rear pillar /front pillar correction was 0.35 ± 0.13 and 0.89 ± 0.18 in the leverage and distraction groups, respectively (p = 0.014). Total correction of the upper and lower foraminal height in the leverage group was significantly less than that in the distraction group. The leverage group had significantly higher correction of the upper and lower intervertebral space height than the distraction group. Our novel leverage technique provided better kyphotic reduction and restoration than compared to conventional distraction technique in the surgical treatment of thoracolumbar compression fractures.

Intraoperative analgesic effect of intravertebral lidocaine injection during percutaneous kyphoplasty in the treatment of thoracolumbar compression fractures in elderly patients.

In recent years, percutaneous kyphoplasty (PKP) has been increasingly used in clinical settings. In this study, we aimed to determine the analgesic effect of intravertebral lidocaine injections in PKP. A total of 60 patients who were treated with PKP were enrolled in this study. Lidocaine hydrochloride was chosen as the medication for the experimental group. Patients were randomly assigned into three groups using a double-blind study design: In group A (20 cases), no drugs were injected into the vertebral body during surgery; group B (20 cases) received intravertebral injection of normal saline; and in group C (20 cases), lidocaine hydrochloride was administered into the vertebral body during surgery. The age of patients, operation time, balloon dilatation pressure, balloon dilatation volume, and amount of bone cement injected were compared across the three groups. A pain visual analog scale (VAS) was used to assess pain suffered by the patients before, during, and 24 hours after the surgery. Age, operation time, balloon dilatation pressure, balloon dilatation volume, and amount of bone cement injected did not differ significantly among the three groups (P> 0.05). The differences in VAS scores 24 hours before and after surgery were not statistically significant (P> 0.05). Group C had lower intraoperative VAS scores than groups A and B, and the difference was statistically significant (P< 0.01). There was no statistically significant difference between group A and group B (P> 0.05). Intravertebral injections of lidocaine during PKP can successfully reduce intraoperative pain.

A combination of digital design and three-dimensional printing to assist treatment of thoracolumbar compression fractures using percutaneous kyphoplasty

ObjectiveTo evaluate the clinical efficacy of the preoperative digital design combined with three-dimensional (3D) printing models to assist percutaneous kyphoplasty (PKP) treatment for thoracolumbar compression fractures. MethodsFrom January 2018 to August 2020, we obtained data of 99 patients diagnosed thoracolumbar compression fractures. These patients were divided into control group (n = 50) underwent traditional PKP surgery, and observation group (n = 49) underwent preoperative digital design combined with 3D printing model assisted PKP treatment. The clinical efficacy was evaluated with five parameters, including operation time, number of intraoperative radiographs, visual analogue scale (VAS) score, Cobb Angle change, and high compression rate of injured vertebrae. ResultsThere were statistically significant differences of operation time and number of intraoperative radiographs between the two groups (P < 0.05). For VAS score, Cobb Angle change and vertebral height compression rate, all of these three parameters were significantly improved when the patients accepted surgery treatment in two groups (P < 0.05). However, there were no significant differences between control group and observation group for these three parameters either before or after surgery (P > 0.05). ConclusionsThrough the design of preoperative surgical guide plate and the application of 3D printing model to guide the operation, the precise design of preoperative surgical puncture site and puncture Angle of the injured vertebra was realized, the number of intraoperative radiographs was reduced, the operation time was shortened and the operation efficiency was improved.

Percutaneous curved vertebroplasty in the treatment of thoracolumbar osteoporotic vertebral compression fractures: a prospective study

Objective To investigate the clinical effect of percutaneous curved vertebroplasty in the treatment of thoracolum-bar osteoporotic vertebral compression fractures (OVCFs). Methods All of 85 patients with single thoracolumbar vertebral OVCFs who met the admission criteria from January 2017 to July 2018 were divided into three groups according to the random dig-its table method. They were treated with percutaneous curved vertebroplasty, routine unipedicular PVP and routine bipedicular PVP respectively. There were 25 patients in the percutaneous curved vertebroplasty group, 6 males and 19 females; aged 56-80 years, with an average age of 70.6±9.7 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 3 cases, L1 9 cases, L2 3 cases, L3 1 case, L4 1 case and L5 2 cases. There were 32 patients in the routine unipedicular PVP group, 6 males and 26 fe-males; aged 58-75 years, with an average age of 69.5±9.3 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 5 cases, L1 11 cases, L2 6 cases, L3 1 case, L4 1 case and L5 2 cases. There were 28 patients in the routine bipedicular PVP group, 5 males and 23 females; aged 59-81 years, with an average age of 69.8±8.8 years. Fracture vertebral body distribution: T10 2 cases, T11 4 cases, T12 4 cases, L1 10 cases, L2 4 cases, L3 1 case, L4 1 case and L5 2 cases. The operation time, injected cement volume, in-traoperative blood loss were recorded and analyzed. Preoperative, postoperative 1 week and 3 months visual analogue scale scores and oswestry disability index were adopted to value the clinical improvements. Preoperative, postoperative 1 week and 3 months relative vertebral height and kyphosis correction, and the cement leakage rate were measured and analyzed. Results There was no significant difference in the data of gender, age, VAS scores, ODI and distribution of fracture vertebrae among the three groups (P>0.05), and the baseline data was comparable. The average VAS score in the percutaneous curved vertebroplasty group was 2.3±0.5 at 1 week after surgery, that of the routine unipedicular PVP group was 2.4±0.4 and that of the routine bipe-dicular PVP group was 2.4±0.4; the average ODI in the percutaneous curved vertebroplasty group was 19.8%±3.9%, that of the routine unipedicular PVP group was 20.0%±4.1% and that of the routine bipedicular PVP group was 19.9%±3.8%; they were lower than the preoperative data, which were statistically significant (P 0.05). Operation time 39.10±2.00 min vs 38.70±1.70 min, injected cement volume 3.60±0.11 ml vs 3.50±0.13 ml and blood loss 5.10±0.30 ml vs 5.00±0.40 ml of the percutaneous curved vertebroplasty group and the routine unipedicular PVP group were less than those of the routine bipedicular PVP group, which were statistically significant (P<0.05). Conclution Percutaneous curved vertebroplasty could achieve satisfactory clinical outcomes for OVCFs, with advantages of less operation time, less blood loss, limited X-ray expo-sure, less injected cement volume, and more balanced augmentation for stabilization of the affected vertebrae and total verte-bral column. Key words: Thoracic vertebrae; Lumbar vertebrae; Osteoporosis; Spinal fractures; Vertebroplasty

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

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

Clinical efficacy of percutaneous kyphoplasty in management of osteoporotic thoracolumbar vertebral compression fracture in the elderly

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty (PKP) in surgical treatment of osteoporotic thoracolumbar vertebral compression fracture in the elderly. Methods From March 2007 to February 2013, 210 cases (100 males and 110 females; 55-91 years of age, mean 72.5 years) of osteoporotic vertebral compression fracture were treated with PKP. Single-segment fracture was observed in 180 cases, two-segment fracture in 20 cases and three-segment fracture in 10 cases. Lesion involved in 250 vertebrae located in the T6-L5 segment. Bone cement injected into each vertebra was 3-5 ml (mean, 4 ml). Treatment effects were assessed with vertebral height, Cobb angle and visual analogue score (VAS). Results At the follow-up of 6-15 months (mean 11 months), thoracic back pain significantly alleviated or disappeared. After operation, improvements were observed in VAS[(8.7±1.2) points vs (2.6±0.7) points], anterior vertebral height loss [(11.0±3.2) mm vs(5.5±0.8) mm], central vertebral height loss [(8.6±1.1) mm vs (3.3±1.0) mm], and Cobb angle [(29.8±4. 5)° vs (16.7±3.4)°] (P <0.01). Four patients appeared no pain or numbness in lower limbs although cement leak into disc. Whereas two patients had lower extremity nerve irritation because of cement leak into the spinal canal and recovered after symptomatic treatment. Conclusion PKP is an effective method for treatment of osteoporotic vertebral compression fracture in the elderly, for it can rebuild vertebral height, increase vertebral rigidity as well as stability and relieve thoracic back pain. Key words: Spinal fractures; Osteoporosis; Percutaneous kyphoplasty

微创经皮椎弓根螺钉系统治疗胸腰椎压缩性骨折复位技术探讨

目的：探讨微创经皮椎弓根螺钉系统治疗胸腰椎压缩性骨折理想的复位技术。方法：选择成都体育学院附属体育医院2012年7月~2013年10月通过微创经皮椎弓根螺钉系统治疗的胸腰段单节段压缩性骨折患者26例，通过观测术前、术后3天的后凸Cobb角、伤椎前缘高度百分比(FVHR)变化，对复位效果进行评价。结果：采用体位复位及万向椎弓根螺钉复位内固定1例，术前Cobb角19˚、FVHR45.7%，术后Cobb角19˚、FVHR 67.9%；采用手法及体位复位、万向椎弓根螺钉复位内固定3例，术前Cobb角平均18.7、FVHR平均52.4%，术后Cobb角平均5.7˚、FVHR平均87.7%；采用手法及体位复位、直向椎弓根螺钉复位内固定22例，术前Cobb角平均17 ± 5.6°、FVHR 51.5 ± 8.3%，术后Cobb角平均3.2 ± 2.5°、FVHR平均94.5 ± 3.6%。结论：采用术前手法复位及体位复位、结合术中直向椎弓根螺钉的器械复位，是微创经皮椎弓根螺钉系统治疗胸腰椎压缩性骨折的有效复位技术。 Objective: To investigate the reasonable fracture reduction technology of minimally invasive per-cutaneous pedicle screw system in the treatment of thoracolumbar compression. Method: From July 2012 to October 2013, 26 patients with thoracolumbar single segmental fracture were treated by percutaneous pedicle screw system, and observation were conducted to investigate the injured vertebra reduction result, along with the anterior vertebral height ratio (FVHR) and Cobb angle within 3 days, to evaluate the effect of reduction. Results: 1 case was treated by the postural re-duction and universal pedicle screw internal fixation, with preoperative FVHR at 45.7%, and 67.9% within 3 days, the preoperative Cobb angle at 28°, and 19° within 3 days; 3 case were treated by manipulation and postural reduction, universal pedicle screw internal fixation, with the average preoperative FVHR at 52.4%, and 87.7% within 3 days, the average preoperative Cobb angle at 18.7°, and 5.7° within 3 days. 22 case was treated by manipulation and postural reduction, straight pedicle screw internal fixation, with the average preoperative FVHR at 56.5 ± 4.3%, and 94.5 ± 3.6% within 3 days, the average preoperative Cobb angle at 17 ± 5.6°, and 3.2 ± 2.5° within 3 days. Con-clusion: The method of preoperative manipulative reduction and postural reduction, combined with surgery to reposition in the straight pedicle screw, is an effective reduction technique in minimally invasive percutaneous pedicle screw system in treatment of thoracolumbar compression fracture.

Treatment of thoracolumbar fracture with pedicle screws at injury level: a biomechanical study based on three-dimensional finite element analysis

The aim of this study was to investigate the biomechanical mechanisms of treatment of thoracolumbar compression fracture with pedicle screws at injury level based on a three-dimensional finite element method. We constructed one three-dimensional finite element model of T11-L1 in a patient with a compression fracture of the T12 vertebral body(anterior edges of vertebral body were compressed to 1/2, and kyphosis Cobb angle was 18.6°) fixed by four pedicle screws and another model fixed by six pedicle screws at the injured vertebrae, and then assigned different forces to the two models to account for axial compression, flexion, extension, left lateral bending, and rightward axial rotation by Ansys software. After different loading forces were applied to the models, we recorded stress measurements on the vertebral pedicle screws, as well as the maximum displacement of T11. The stress distribution suggested that stress concentration was appreciable at the root of the pedicle screws under different loading modalities. Under axial compression, flexion, extension, left lateral bending, and rightward axial rotation load, the stress for the superior screw was significantly greater than the stress for the inferior screw (P < 0.05). The stress in the six pedicle screw fixation model was significantly decreased compared to the four screw interbody fusion model (P < 0.05), but the maximum displacement of T11 between two models under different loadings was not statistically different. The use of pedicle screws at injured vertebral bodies may optimize internal fixation load and reduce the incidence of broken screws.

Comparative analysis on curative effects of percutaneous vertebroplesty and kyphoplasty in the treat-ment for thoracolumbar vertebral compression fracture

[Objective]To explore and compare the clinical efficacy of treatment of thoracolumbar vertebral compression fracture by percutaneous vertebroplasty(PVP) and percutaneous kyphoplasty(PKP).[Methods]46 cases of thoracolumbar vertebral compression fractures in patients with surgical Methods were divided into vertebral angioplasty group and kyphoplasty group,intraoperative blood loss of two groups,operative time,the bone cement injected volume,bone cement leakagerate and clinical efficacy before and after surgery were compared in two groups.Resrlts Patients were successfully completed with surgery,infection,complications of hematoma,nerve root injury,and vertebral body fractures.There was no statistical significant difference in operative time and blood loss in two groups(P＞ 0.05).But there was significant differences in the injection volume of hone cement,bone cement leakage rate between the two groups (P＜0.05).Two groups' restoring vertebral height extent had significant improvement in VAS score than the preoperative group,difference was statistically significant (P＜ 0.05) but no significant difference found between two groups (P＞ 0.05).Mter 2weeks in PVP group,and the PKP group,1 year after the efficiency difference was not significant (P＞ 0.05).[Conclusion]s PVP and PKP treatment of thoracic and lumbar vertebral compression fracture may derive significant clinical efficacy,with less trauma,shorter operative time,less bleeding,fewer complications,minimally invasive characteristics.PKP can effectively correct the kyphosis,greatly reduce the occurrence of bone cement leakage than PVP increased security,hut the cost is higher; PVP operation is relatively simple,inexpensive,hut the bone cement leakage rate is relatively high.It should be combined with a vasiety of factors to select the appropriate surgical clinical. Key words: Percutaneous vertebroplasty(PVP); Percutaneous kyphoplasty(PKP); Compression fracture; Osteoporosis; Bone cement; Curative effect

Prevention of thoracolumbar osteoporotic compression fracture with transpedicular intracorporeal bone graft with allogenic bone

Objective To evaluate the clinical efficacy of transpedicular intracorporeal bone graft with allogenic bone in treatment of thoracolumbar osteoporotic compression fracture. Methods A total of 45 patients with thoracolumbar osteoporotic compression fractures were treated with posterior short segment pedicle screw fixation and transpedicular intracorporeal bone graft with allogenic bone. Anteroposte-rior and lateral X-ray photographs were taken before and after operation and at follow up period to determine the ratio of anterior and middle compressed body height to the normal height, the vertebral angle and the superior-inferior endplate angle. The extent of local pain was measured by VAS score. The implant failure was also recorded during follow-up. Results The operative reduction and interbody bone grafting exerted a satisfactory effect on the ratio of anterior and middle body height to the normal height, the vertebral angle and the superior-inferior endplate angle. Local back pain disappeared immediately after surgery in 34 patients out of 38 patients followed up for more than two years. No implant failure was found during follow-up. Conclusions Early treatment with posterior short segment pedicle screw fixation and transpedicular intracorporeal bone graft with allogenic bone can effectively correct local deformity, prevent late vertebral collapse and implant failure and is an ideal treatment method for thoracolumbar osteoporotic compression fracture. Key words: Spinal fractures; Thoracic vertebrae; Lumbar vertebrae; Osteoporosis; Allogenic bone

Treatment of thoracolumbar compression fractures with transpedicular bone grafting on basis of bone loss calculation

对胸腰段椎体压缩性骨折采用后路短节段内固定结合经伤椎椎弓根椎体植骨已在临床广泛应用[1-2].但是,对植骨量的多少,却仅凭术者的感觉或估算,可能导致植骨量的不足而产生椎体再塌陷[3-4]。

Percutaneous vertebroplasty for treatment of osteoporotic thoracolumbar vertebral compression fracture by filling auto-solidification calcium phosphate cement

目的 探讨应用经皮椎体成形术(PVP)自固化磷酸钙人工骨(CPC)充填治疗骨质疏松性胸腰椎压缩性骨折的临床疗效.方法自2004年1月起,对26例29个椎体骨质疏松性胸腰椎压缩骨折患者,采用术中手法复位、PVP 自固化CPC充填治疗.结果 26例患者经单侧或双侧椎弓根穿刺椎体成形术成功治愈.胸腰椎自固化CPC平均充填量为4.6 mL.术中CPC渗漏者5例5个椎体.无一例出现严重并发症.经3～8个月(平均4.6个月)随访,术后所有患者疼痛消失.除3例椎体高度丢失15%外,其余椎体高度平均恢复达正常的80%.结论 PVP自固化CPC充填治疗骨质疏松性胸腰椎压缩性骨折是一种安全、简单、有效的方法。