Effect of the vertebroplasty for vertebral compression fractures of screw-setting segment after thoracolumbar internal fixation

doi:10.3969/j.issn.1009-976X.2020.05.012

Abstract

Abstract: Objective To investigate the clinical effect of vertebroplasty in the treatment of vertebral compression fracture of screw-setting level after thoracolumbar pedicle screw fixation. Methods From June 2016 to June 2019, a total of 12 patients with vertebral compression fractures of screw-setting segment after thoracolumbar internal fixation were treated with vertebroplasty in Zengcheng People's Hospital, Guangzhou. Postoperative observation included bone cement leakage, re-fracture and instrumental loosen and failure. Visual analogue scale （VAS）, vertebral compression rate and Cobb Angle were collected before vertebroplasty and 3 days, 1 month, 3 months, 6 months and 12 months after vertebroplasty. Results All patients were followed up for 12 months. There was only 1 case of bone cement leakage, no re-fracture, instrumental loosen and failure. There were statistically significant differences between before and after vertebroplasty in lumbar VAS score, vertebral compression rate and Cobb Angle （P<0.05）. Compared with 1 month after vertebroplasty, 3 months, 6 months and 12 months after vertebroplasty had no statistically significant differences in lumbar VAS score, vertebral compression rate and Cobb Angle （P>0.05）. Conclusion Vertebroplasty is an effective treatment for thoracolumbar vertebral compression fracture of screw-setting segment after thoracolumbar internal fixation, which could significantly relieve the lower back pain, prevent the re-fracture and instrumental loosen and failure.

Key words: thoracolumbar internal fixation, osteoporotic vertebral compression fracture, vertebroplasty, fracture of screw-setting segment

摘要： 目的探讨椎体成形术在治疗胸腰椎内固定术后置钉椎压缩性骨折的临床疗效。方法 2016 年 6月至2019年6月期间,共有12例胸腰椎内固定术后置钉椎压缩性骨折患者于广州市增城区人民医院采用椎体成形术治疗。术后观察有无骨水泥渗漏、再次骨折及内固定松动断裂;收集手术前、术后3天、术后1月、术后3月、术后6月、术后12月患者疼痛视觉模拟评分（VAS）、椎体压缩率及Cobb 角。结果所有患者随访12个月。仅1例发生骨水泥渗漏,无椎体再次骨折,无内固定松动断裂。术后腰背部VAS评分、椎体压缩率及Cobb 角相比术前具有统计学差异（P<0.05）。术后1月和术后3月、术后6月、术后12月对比,腰背部VAS评分、椎体压缩率及Cobb 角相比无统计学差异（P>0.05）。结论椎体成形术用于治疗胸腰椎内固定术后置钉椎压缩性骨折可明显缓解腰背部疼痛,预防再次骨折、内固定松动断裂,是一种有效的治疗方法。

关键词: 胸腰椎内固定, 置钉椎骨折, 椎体压缩性骨折, 椎体成形术

CLC Number:

R683.2

XIAO Jin-yu, YE Ji-chao, WANG Zhen. Effect of the vertebroplasty for vertebral compression fractures of screw-setting segment after thoracolumbar internal fixation[J]. Lingnan Modern Clinics in Surgery, 2020, 20(05): 601-604.

萧锦瑜, 叶记超, 王振. 椎体成形术治疗胸腰椎内固定术后置钉椎压缩性骨折疗效观察[J]. 岭南现代临床外科, 2020, 20(05): 601-604.

References

[1] Mobbs RJ, Sivabalan P, Li J.Technique, challenges and indications for percutaneous pedicle screw fixation[J]. J Clin Neurosci, 2011, 18(6):741-749.
[2] Nakahashi M, Uei H, Tokuhashi Y, et al.Vertebral fracture in elderly female patients after posterior fusion with pedicle screw fixation for degenerative lumbar pathology: a retrospective cohort study[J]. BMC Musculoskelet Disord, 2019, 20(1):259.
[3] Park YS, Hyun SJ, Choi HY, et al.Association between bicortical screw fixation at upper instrumented vertebra and risk for upper instrumented vertebra fracture[J]. J Neurosurg Spine, 2017,26(5):638-644.
[4] Seo JY, Ha KY, Son IN, et al.Percutaneous vertebroplasty for cephalad vertebral fractures after instrumented lumbar fusion[J]. J Spinal Disord Tech, 2013, 26(2):E58-E64.
[5] Jay B, Ahn SH.Vertebroplasty[J]. Semin Intervent Radiol, 2013,30(3):297-306.
[6] Keorochana G, Pairuchvej S, Trathitephun W, et al.Comparative outcomes of cortical screw trajectory fixation and pedicle screw fixation in lumbar spinal fusion: systematic review and meta-analysis[J]. World Neurosurg, 2017, 102:340-349.
[7] Li YC, Yang SC, Chen HS, et al. Impact of lumbar instrumented circumferential fusion on the development of adjacent vertebral compression fracture [J]. Bone Joint J, 2015,97-B(10):1411-1416.
[8] Parreira P, Maher CG, Megale RZ, et al.An overview of clinical guidelines for the management of vertebral compression fracture: a systematic review[J]. Spine J, 2017,17(12):1932-1938.
[9] Goldstein CL, Chutkan NB, Choma TJ, Orr RD.Management of the Elderly With Vertebral Compression Fractures[J]. Neurosurgery, 2015,77(Suppl 4):S33-S45.
[10] Buchbinder R, Johnston RV, Rischin KJ, et al.Percutaneous vertebroplasty for osteoporotic vertebral compression fracture[J]. Cochrane Database Syst Rev, 2018,4(4):D6349.
[11] Buchbinder R, Golmohammadi K, Johnston RV, et al. Percutaneous vertebroplasty for osteoporotic vertebral compression fracture [J]. Cochrane Database Syst Rev, 2015, 4(4): CD006349.
[12] Yang SC, Chen HS, Kao YH, et al.Percutaneous vertebroplasty for symptomatic osteoporotic vertebral compression fracture adjacent to lumbar instrumented circumferential fusion[J]. Orthopedics, 2012,35(7):e1079-e1085.
[13] Ahn Y, Lee SH.Vertebroplasty for adjacent vertebral fracture following lumbar interbody fusion[J]. Br J Neurosurg, 2011,25(1):104-108.
[14] Hart RA, Prendergast MA, Roberts WG, et al.Proximal junctional acute collapse cranial to multi-level lumbar fusion: a cost analysis of prophylactic vertebral augmentation[J]. Spine J, 2008,8(6):875-881.
[15] El SA, Meier S, Sander A, et al.Reduced loosening rate and loss of correction following posterior stabilization with or without PMMA augmentation of pedicle screws in vertebral fractures in the elderly[J]. Eur J Trauma Emerg Surg, 2013,39(5):455-460.
[16] Galbusera F, Volkheimer D, Reitmaier S, Berger-Roscher N, Kienle A, Wilke HJ.Pedicle screw loosening: a clinically relevant complication?[J]. Eur Spine J, 2015,24(5):1005-1016.