Treatment of chronic thoracolumbar osteoporotic fractures combined with kyphosis with cement-injectable cannulated pedicle screw and multiple level Schwab grade <b>Ⅰ</b> osteotomy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Di ^1,2 , ZHANG Wenming ¹ , ZHOU Xianwei ¹ , SHEN Huiyong ² ,  JIN Song ²

1. Department of Spinal Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 450000, P.R.China;
2. Department of Orthopedics, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen Guangdong, 518033, P.R.China;

Corresponding author：

JIN Song, Email: jingsosysu@tom.com

Keywords：

Cement-injectable cannulated pedical screw; Schwab gradeⅠosteotomy; osteoporosis; thoracolumbar fracture; kyphosis

DOI：

10.7507/1002-1892.202006129

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Objective To evaluate the effectiveness of cement-injectable cannulated pedicle screw combined with multiple level Schwab grade Ⅰ osteotomy for chronic thoracolumbar osteoporotic fractures with kyphosis.Methods The clinical data of 27 patients with symptomatic chronic thoracolumbar osteoporotic fractures combined with kyphosis treated between June 2015 and June 2017 were retrospectively analysed. Among them, there were 8 males and 19 females, with an average age of 69.5 years (range, 56-81 years). The damage segment (kyphosis vertex) included T₁₁ in 4 cases, T₁₂ in 12 cases, L₁ in 10 cases, and L₂ in 1 case. The disease duration ranged from 3 to 21 months, with an average of 12.5 months. The T value of lumbar vertebral bone mineral density ranged from −4.9 to −2.5, with an average value of −3.61. The American Spinal Injury Association (ASIA) classification was used to evaluate spinal cord injury, there were 1 case of grade D and 26 cases of grade E. The visual analogue scale (VAS) score, Oswestry disability index (ODI), kyphosis Cobb angle of fracture site, and sagittal vertical axis (SVA) data were obtained before operation, at 2 weeks after operation, 3 months after operation, and last follow-up, to evaluate the quality of life and improvement of sagittal spine parameters.Results No complications related to pedicle screw and bone cement occurred. The incisions healed by first intention in 26 cases, and 1 incision healed after dressing change due to poor blood glucose control. There were no complications such as bedsore, hypostatic pneumonia, or deep venous thrombosis. All patients were followed up 8-24 months, with an average of 16.6 months. The VAS score, ODI score, Cobb angle, and SVA were significantly improved when compared with those before operation (P<0.05). There was no significant difference in Cobb angle between each time point after operation (P>0.05); the VAS score and ODI score at 3 months after operation and last follow-up were significantly better than those at 2 weeks after operation (P<0.05), and the ODI score at last follow-up was further improved when compared with the score at 3 months (P<0.05), but there was no significant difference in VAS score (P>0.05); SVA at last follow-up was significantly worse than that at 2 weeks and 3 months after operation (P<0.05), but there was no significant difference between at 2 weeks and 3 months after operation (P>0.05). During the follow-up period, there was no complication such as pedicle screw loosening, breakage or cutting, adjacent vertebral fracture, proximal junctional kyphosis, and so on.Conclusion For the chronic thoracolumbar osteoporotic fractures combined with kyphosis, the cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy has the advantages of less operation trauma, quick recovery, and remarkable effectiveness.

Citation： ZHANG Di, ZHANG Wenming, ZHOU Xianwei, SHEN Huiyong, JIN Song. Treatment of chronic thoracolumbar osteoporotic fractures combined with kyphosis with cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1533-1538. doi: 10.7507/1002-1892.202006129 Copy

1.	Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet, 2002, 359(9319): 1761-1767.
2.	Zaryanov AV, Park DK, Khalil JG, et al. Cement augmentation in vertebral burst fractures. Neurosurg Focus, 2014, 37(1): E5.
3.	王琨, 杨操, 杨述华, 等. 陈旧性胸腰椎骨折伴后凸畸形的截骨矫形术式选择. 中国脊柱脊髓杂志, 2016, 26(1): 24-29.
4.	毛贝尼, 张钟, 付维力, 等. 中国骨质疏松性骨折疾病负担的系统评价. 中国循证医学杂志, 2018, 18(2): 151-155.
5.	中华医学会骨科学分会骨质疏松学组. 骨质疏松性骨折诊疗指南. 中华骨科杂志, 2017, 37(1): 1-10.
6.	Schwab F, Patel A, Ungar B, et al. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976), 2010, 35(25): 2224-2231.
7.	张义龙, 任磊, 孙志杰, 等. 椎体成形术后新发椎体骨折与脊柱矢状位参数的相关性分析. 重庆医学, 2017, 46(4): 483-485.
8.	Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery, 2014, 74(1): 112-120.
9.	张银昌, 赵清华, 秦晓东, 等. SRS-Schwab Ⅳ级截骨联合卫星棒技术治疗胸腰椎陈旧性骨质疏松性骨折伴严重后凸畸形. 中国修复重建外科杂志, 2019, 33(3): 259-264.
10.	Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2037.
11.	Halvorson TL, Kelley LA, Thomas KA, et al. Effects of bone mineral density on pedicle screw fixation. Spine (Phila Pa 1976), 1994, 19(21): 2415-2420.
12.	McLain RF, McKinley TO, Yerby SA, et al. The effect of bone quality on pedicle screw loading in axial instability. A synthetic model. Spine (Phila Pa 1976), 1997, 22(13): 1454-1460.
13.	Pezowicz C, Filipiak J. Influence of loading history on the cervical screw pullout strength value. Acta Bioeng Biomech, 2009, 11(3): 35-40.
14.	Rohmiller MT, Schwalm D, Glattes RC, et al. Evaluation of calcium sulfate paste for augmentation of lumbar pedicle screw pullout strength. Spine J, 2002, 2(4): 255-260.
15.	Tai CL, Tsai TT, Lai PL, et al. A biomechanical comparison of expansive pedicle screws for severe osteoporosis: The effects of screw design and cement augmentation. PLoS One, 2015, 10(12): e0146294.
16.	Hsu WL, Lin YH, Chuang HY, et al. Cortical bone trajectory instrumentation with vertebroplasty for osteoporotic thoracolumbar compression fracture. Medicina (Kaunas), 2020, 56(2): 82.
17.	Yang SC, Liu PH, Tu YK. Pullout evaluation of sawbone experiment in different types of pedicle screws combined with bone cement augmentation for severe osteoporotic spine. Acta Bioeng Biomech, 2018, 20(2): 55-64.
18.	Kiyak G, Balikci T, Heydar AM, et al. Comparison of the pullout strength of different pedicle screw designs and augmentation techniques in an osteoporotic bone model. Asian Spine J, 2018, 12(1): 3-11.
19.	陈晓峰, 李浩, 欧志聪, 等. 不同置钉和骨水泥剂量对椎弓根螺钉固定强度的影响. 中国矫形外科杂志, 2019, 27(14): 1306-1310.
20.	Liu YY, Xiao J, Yin X, et al. Clinical efficacy of bone cement-injectable cannulated pedicle screw short segment fixation for lumbar spondylolisthesis with osteoporosise. Sci Rep, 2020, 10(1): 3929.
21.	陈建良, 许勇, 万蕾, 等. 老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形后路截骨矫形的术式选择. 中国骨伤, 2020, 33(2): 121-126.
22.	张健, 王小健, 秦德安, 等. 脊柱矫形后发生近端交界性后凸危险因素的荟萃分析. 中国组织工程研究, 2020, 24(3): 460-468.

1. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet, 2002, 359(9319): 1761-1767.
2. Zaryanov AV, Park DK, Khalil JG, et al. Cement augmentation in vertebral burst fractures. Neurosurg Focus, 2014, 37(1): E5.
3. 王琨, 杨操, 杨述华, 等. 陈旧性胸腰椎骨折伴后凸畸形的截骨矫形术式选择. 中国脊柱脊髓杂志, 2016, 26(1): 24-29.
4. 毛贝尼, 张钟, 付维力, 等. 中国骨质疏松性骨折疾病负担的系统评价. 中国循证医学杂志, 2018, 18(2): 151-155.
5. 中华医学会骨科学分会骨质疏松学组. 骨质疏松性骨折诊疗指南. 中华骨科杂志, 2017, 37(1): 1-10.
6. Schwab F, Patel A, Ungar B, et al. Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine (Phila Pa 1976), 2010, 35(25): 2224-2231.
7. 张义龙, 任磊, 孙志杰, 等. 椎体成形术后新发椎体骨折与脊柱矢状位参数的相关性分析. 重庆医学, 2017, 46(4): 483-485.
8. Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery, 2014, 74(1): 112-120.
9. 张银昌, 赵清华, 秦晓东, 等. SRS-Schwab Ⅳ级截骨联合卫星棒技术治疗胸腰椎陈旧性骨质疏松性骨折伴严重后凸畸形. 中国修复重建外科杂志, 2019, 33(3): 259-264.
10. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2037.
11. Halvorson TL, Kelley LA, Thomas KA, et al. Effects of bone mineral density on pedicle screw fixation. Spine (Phila Pa 1976), 1994, 19(21): 2415-2420.
12. McLain RF, McKinley TO, Yerby SA, et al. The effect of bone quality on pedicle screw loading in axial instability. A synthetic model. Spine (Phila Pa 1976), 1997, 22(13): 1454-1460.
13. Pezowicz C, Filipiak J. Influence of loading history on the cervical screw pullout strength value. Acta Bioeng Biomech, 2009, 11(3): 35-40.
14. Rohmiller MT, Schwalm D, Glattes RC, et al. Evaluation of calcium sulfate paste for augmentation of lumbar pedicle screw pullout strength. Spine J, 2002, 2(4): 255-260.
15. Tai CL, Tsai TT, Lai PL, et al. A biomechanical comparison of expansive pedicle screws for severe osteoporosis: The effects of screw design and cement augmentation. PLoS One, 2015, 10(12): e0146294.
16. Hsu WL, Lin YH, Chuang HY, et al. Cortical bone trajectory instrumentation with vertebroplasty for osteoporotic thoracolumbar compression fracture. Medicina (Kaunas), 2020, 56(2): 82.
17. Yang SC, Liu PH, Tu YK. Pullout evaluation of sawbone experiment in different types of pedicle screws combined with bone cement augmentation for severe osteoporotic spine. Acta Bioeng Biomech, 2018, 20(2): 55-64.
18. Kiyak G, Balikci T, Heydar AM, et al. Comparison of the pullout strength of different pedicle screw designs and augmentation techniques in an osteoporotic bone model. Asian Spine J, 2018, 12(1): 3-11.
19. 陈晓峰, 李浩, 欧志聪, 等. 不同置钉和骨水泥剂量对椎弓根螺钉固定强度的影响. 中国矫形外科杂志, 2019, 27(14): 1306-1310.
20. Liu YY, Xiao J, Yin X, et al. Clinical efficacy of bone cement-injectable cannulated pedicle screw short segment fixation for lumbar spondylolisthesis with osteoporosise. Sci Rep, 2020, 10(1): 3929.
21. 陈建良, 许勇, 万蕾, 等. 老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形后路截骨矫形的术式选择. 中国骨伤, 2020, 33(2): 121-126.
22. 张健, 王小健, 秦德安, 等. 脊柱矫形后发生近端交界性后凸危险因素的荟萃分析. 中国组织工程研究, 2020, 24(3): 460-468.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of chronic thoracolumbar osteoporotic fractures combined with kyphosis with cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy

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