Pedicle screw fixation combined with vertebroplasty for single-level thoracolumbar osteoporotic burst fractures

Zhang Liang; Wang Jing-cheng; Feng Xin-min; Wang Yong-xiang; Yang Jian-dong; Tao Yu-ping; Zhang Sheng-fei; Huang Ji-jun

doi:10.3969/j.issn.2095-4344.2014.17.017

Abstract：BACKGROUND:Vertebroplasty alone cannot relief spinal canal encroachment and kyphosis malformation for treatment of osteoporotic thoracolumbar fractures. Moreover, the occurrence rate of bone cement leakage is high, which becomes a contraindication for its application. Pedicle screw internal fixation alone may increase the trauma, screw loosening and high incidence of late kyphosis deformity. <br> OBJECTIVE:To observe the therapeutic effects of short-segment pedicle screw fixation through paraspinal approach combined with vertebroplasty for single-level thoracolumbar osteoporotic burst fractures. <br> METHODS:A retrospective study was conducted in 31 cases receiving short-segment pedicle screw fixation through paraspinal approach combined with vertebroplasty for single-level thoracolumbar osteoporotic burst fractures. After fixation, clinical outcomes were evaluated mainly with use of visual analog scale for lower back pain. Functions of lower back pain were assessed using Oswestry Disability Index questionnaire. Quality of life was evaluated using 36-Item Short Form Health Survey. Thoracolumbar anteroposterior and lateral radiographs were utilized to assess anterior vertebral height ratio and the improvement of Cobb angle. Frankel score was applied to evaluate neurological function and complications. <br> RESULTS AND CONCLUSION:Al operations were successful y completed with no spinal cord or nerve damage. Al patients were fol owed up for a mean 24.5 months (12-36 months). Fractured vertebrae reached satisfactory reduction. The average vertebral body height and Cobb angle significantly improved. The low back pain relieved. Low back function and quality of life improved significantly. Al of the above indicators significantly improved (P<0.05). No significant differences were detected between 1-week postoperation and 1-year postoperation (P>0.05). After fixation, two patients affected bone cement leakage, including one in anterior vertebral body and one in intervertebral space. However, they did not have clinical symptoms. During fol ow-up, no loosening or breakage, no new fractures occurred. These results indicated that the combination of this technique with vertebroplasty plus internal fixation through paraspinal approach not only restored and maintained vertebral height and strength, reconstructed spinal stabilization, obviously lessened low back pain, but also could make patients get satisfactory low back function and improved the quality of life. It is an effective method for osteoporotic thoracolumbar fractures with spinal canal encroachment.