2023, Vol. 27 ›› Issue (31): 4954-4958

Percutaneous vertebroplasty under distraction with external spinal fixator for vertebral osteoporotic compression fractures with posterior wall damage

Sun Lingjuan1, Song Xizheng2, Li Daming1, Han Zhenxue2, Kang Yu2, Xiang Hanrui1, Sheng Kai1   

Abstract: BACKGROUND: Posterior wall damaged vertebral osteoporotic compression fracture with spinal canal occupying is often treated by open surgery or conservative therapy at home and abroad. For elderly patients with osteoporosis, with the external spinal fixation device, the axial distraction of the spinal canal occupying the posterior bone block reduction, expansion of the spinal canal, and percutaneous vertebroplasty to solidify the vertebral body achieved good clinical results.  
OBJECTIVE: To observe the clinical effect of percutaneous vertebroplasty of anterior and posterior longitudinal ligaments for osteoporotic compression fracture of vertebral body with posterior wall damage under external spinal fixation.
METHODS: A total of 52 aged patients with osteoporotic compression fracture of vertebral body with posterior wall damage were selected, aged from 61 to 86 years (mean 78.62±5.20 years). The patients were treated with external spinal fixation combined with percutaneous vertebroplasty. X-ray and CT were used to observe the anterior margin height loss, kyphosis angulation, vertebral stenosis, and bone cement distribution in the fractured vertebrae before, 1 day and 3 months postoperatively, during final follow-up (12 months postoperatively). Visual analogue scale score and Oswestry dysfunction index were also evaluated.  
RESULTS AND CONCLUSION: Fifty-two cases were followed up for 3-12 months. X-ray films exhibited that preoperatively and 1 day, 3 months postoperatively, at final follow-up, the loss rates of anterior vertebral body height were (34.5±2.2)%, (3.5±1.3)%, (4.0±0.6)%, and (4.4±1.1)%; the kyphosis angles were (12.1±1.7)°, (4.0±0.8)°, (3.5±0.5)°, and (4.4±0.2)°. CT showed that the spinal stenosis rates were (40.9±7.2)%, (10.7±2.5)%, (9.7±1.1)%, and (9.8±0.7)%. The distribution range of bone cement filling in fractured vertebral bodies was all ≥75%. There were significant differences in visual analogue scale score and Oswestry disability index before and 1 day after treatment (P < 0.05). There was no significant difference in visual analogue scale score and Oswestry disability index between 3 months after surgery and last follow-up (P > 0.05). The results have shown that percutaneous vertebroplasty under anterior posterior longitudinal ligament stretch of the vertebral body not only significantly improves the clinical effect of osteoporotic vertebral compression fracture repair, but also improves the vertebral body solidification rate and relieves pain, which is a safe and effective minimally invasive combination of new technology.

Key words: posterior wall damaged vertebral osteoporotic compression fracture, spinal canal occupying, anterior and posterior longitudinal ligament, stretching, percutaneous vertebroplasty