Minimally Invasive Pedicle Screw Fixation Combined with Percutaneous Kyphoplasty Under O‐Arm Navigation for the Treatment of Metastatic Spinal Tumors with Posterior Wall Destruction

Abstract

Objective To evaluate the safety and efficacy of O‐arm‐guided minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for metastatic spinal tumors with posterior wall destruction. Methods Patients who underwent minimally invasive pedicle screw fixation combined with percutaneous kyphoplasty for pathological vertebral fractures with posterior wall defects from January 2015 to December 2017 were followed up for 1 year. Visual analogue scale (VAS), SF‐36 scores, middle vertebral height, posterior vertebral height, and the accuracy of pedicle screws were assessed preoperatively, postoperatively, and 1 year after surgery. The operation time, time from operation to discharge, blood loss, volume of bone cement, and leakage of bone cement were recorded. Results Twenty‐three patients (13 females and 10 males) who met our criteria were followed up for 1 year. The operation time of these patients was 162.61 ± 33.47 min, the amount of bleeding was 230.87 ± 93.76 mL, the time from operation to discharge was 4.35 ± 2.42 days, and the volume of bone cement was 3.67 ± 0.63 mL. The VAS score decreased from 7.04 ± 1.07 to 2.65 ± 0.93 before surgery (P = 0.000) and remained at 2.57 ± 0.79 1 year after surgery. Compared with the preoperative SF‐36 scores for physical pain, physiological function, energy, and social function, the postoperative scores were significantly improved (P = 0.000). The height of the middle vertebral body increased from 14.47 ± 2.96 mm before surgery to 20.18 ± 2.94 mm (P = 0.000), and remained at 20.44 to 3.01 mm 1 year after surgery. The height of the posterior vertebral body increased from 16.56 ± 3.07 mm before operation to 22.79 ± 4.00 mm (P = 0.000), and 22.45 ± 3.88 mm 1 year after surgery. The 23 patients had a total of 92 pedicle screws; 85 screws were Grade A and 7 screws were Grade B. There was no leakage of bone cement after surgery. Conclusion In the short term, O‐arm‐guided minimally invasive pedicle screw fixation combined with kyphoplasty is safe and effective in the treatment of metastatic spinal tumors with posterior wall destruction.

Systematic review and meta-analysis of the effect of using percutaneous pedicle screw internal fixation for thoracolumbar fractures

“…Percutaneous pedicle screw surgery requires an incision of approximately 1 cm in length at each screw placement site. This incision is used to insert the needle, guide wire, and dilator tube, and the screw was screwed in with the help of the guide wire (23). The dilatation tube bluntly separates the soft tissues of the lower back and paraspinal muscles, avoiding the extensive dissection and electrosurgical burning required in open surgery.…”

Transoral balloon kyphoplasty in a myeloma patient with painful osseous destruction of the corpus vertebrae axis

“…In the presence of symptomatic pathological fractures and/or osseous destruction of the axial skeleton, cement augmentation by means of vertebroplasty [ 18 , 19 ] or balloon kyphoplasty (BKP) [ 20–22 ] has already proven effective for rapid pain reduction, and both procedures were included in a consensus statement from the IMWG [ 23 ]. In order to achieve sufficient stabilization, BKP is sometimes performed in combination with screw osteosynthesis [ 24 ] or spondylodesis [ 25 ].…”

O-Arm- and Guide-Device-Assisted Personalized Percutaneous Kyphoplasty for Thoracolumbar Osteoporotic Vertebral Compression Fractures

“…Many advanced techniques have been used to assist in PKP [4][5][6][7][8][9][10][11][12][13], including surgical robots [4][5][6][7][8], real-time ultrasound volume navigation [9], DynaCT [10] and O-arm navigation [11][12][13]. However, these technologies are expensive and/or have high technical requirements; thus, they cannot be widely used in primary hospitals.…”

“…In recent years, O-arm navigation, which provides very helpful intraoperative imaging, has been widely used in most spinal surgeries [11][12][13][22][23][24][25][26][27]. O-arm navigation can provide an accurate needle entry point and puncture trajectory, as well as an accurate location of vertebral lesions.…”