Cement augmentation in vertebral burst fractures

Abstract

<jats:p>As a result of axial compression, traumatic vertebral burst fractures disrupt the anterior column, leading to segmental instability and cord compression. In situations with diminished anterior column support, pedicle screw fixation alone may lead to delayed kyphosis, nonunion, and hardware failure. Vertebroplasty and kyphoplasty (balloon-assisted vertebroplasty) have been used in an effort to provide anterior column support in traumatic burst fractures. Cited advantages are providing immediate stability, improving pain, and reducing hardware malfunction. When used in isolation or in combination with posterior instrumentation, these techniques theoretically allow for improved fracture reduction and maintenance of spinal alignment while avoiding the complications and morbidity of anterior approaches. Complications associated with cement use (leakage, systemic effects) are similar to those seen in the treatment of osteoporotic compression fractures; however, extreme caution must be used in fractures with a disrupted posterior wall.</jats:p>

Lavage prior to vertebral augmentation reduces the risk for cement leakage

“…While other studies found a higher complication and leakage rate in the augmentation of burst fractures [34], in our study population A1.2 fractures (wegde-impaction) showed a higher leakage rate compared to other fracture forms. The cause for this may be iatrogenically higher PMMA insertion pressures in an attempt to achieve endplate-to-endplate filling in this fracture type, in which one endplate is still intact.…”

Management of Osteoporotic and Neuropathic Ankle Fractures in the Elderly

“…It is unknown whether the augmentation would affect the healing process or whether cyclic loading during rehabilitation would cause the augmentation to become dislodged and migrate [29]. Augmentation of screws in the osteoporotic bone with polymethyl methacrylate (PMMA) is commonly used in fractures of the spine [30, 31] and has been reported in calcaneal fractures [32]. There are no reports on the use of PMMA-augmented screws in osteoporotic ankle fractures.…”

Percutaneous Treatment of Vertebral Fractures

“…By reexpanding the vertebra with balloon tamps, KP reduces the pathologic kyphosis in 60% of patients, improving the restoration of normal vertebral biomechanics, early mobilization, and pain relief in 90% of cases. [19][20][21] Compared with VP, BKP offers superior pain relief at the short-term follow-up with a significant reduction of the visual analog scale (VAS) of pain and improvement of the Oswestry Disability Index (ODI) score. [19][20][21][22][23] Complications Cement venous leakages and new VCFs at distant or adjacent levels are the more frequent complications of this approach.…”

“…[19][20][21] Compared with VP, BKP offers superior pain relief at the short-term follow-up with a significant reduction of the visual analog scale (VAS) of pain and improvement of the Oswestry Disability Index (ODI) score. [19][20][21][22][23] Complications Cement venous leakages and new VCFs at distant or adjacent levels are the more frequent complications of this approach. Compared with VP, BKP has an inferior rate of cement leakage thanks to the cavity created by the balloon system tamp; cement is injected in low-pressure conditions with a significant reduction of the risk of cement leak.…”