One Approach Anterior Decompression and Fixation with Posterior Unilateral Pedicle Screw Fixation for Thoracolumbar Osteoporotic Vertebral Compression Fractures

Abstract

Objective The objective of the present paper was to explore the clinical effect of one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation for thoracolumbar osteoporosis vertebral compression fractures (OVCF). Methods This is a single‐center retrospective analysis. A total of six thoracolumbar OVCF patients (four women and two men) with an average age of 65.2 years (58–72 years) who were treated between June 2016 and May 2018 were enrolled in the present study. The lesion segments included: 1 case at T11, 1 case at T12, 3 cases at L1, and 1 case at L2. The six thoracolumbar OVCF patients were treated with one approach anterior decompression and fixation with posterior unilateral pedicle screw fixation. After general anesthesia, patients were placed in the right lateral decubitus position, an approximately 10–15‐cm oblique incision was made along corresponding ribs, and the conventional left retroperitoneal and/or the extrapleural approach was performed for anterior lateral exposure. First, anterior decompression and fixation were performed, and then through the unilateral paraspinal muscle approach, posterior pedicle screw fixation was performed under the same incision. The back pain visual analogue scale (VAS), the Oswestry disability index (ODI), and the MacNab criteria were used to evaluate the clinical outcome. The radiographic analysis included the regional kyphosis angle and the fusion rate. Neurological status, operation time, intraoperative bleeding, the time of ambulation, hospital stay, and surgical complications were also assessed. Results Surgery was successful in all six patients, who were followed up for 31.6 months (range, 23–46 months). The operation time was 125–163 min, with a median of 135 min. The preoperative blood loss was 580–1230 mL, with a median of 760 mL. The time of ambulation was 3–5 days, with a median of 4.2 days. The hospital stay was 8–15 days, with the median of 10.5 days. According to the Frankel classification of neurological deficits, of two patients with grade C preoperatively, one had improved to grade D and one had improved to grade E at final follow up; among four patients with grade D preoperatively, at the final follow up one remained the same and three had improved to grade E. The postoperative back pain VAS score decreased significantly, from 6.17 ± 0.75 preoperatively to 0.83 ± 0.41 postoperatively (P < 0.05). The mean ODI score was 73.7 ± 5.86 preoperatively and reduced to 21.85 ± 3.27 postoperatively (P < 0.05). According to the MacNab criteria, at the final follow up, two patients rated their satisfaction as excellent, three patients as good, and one patient as fair. The mean regional kyphosis angle was 22.17° ± 6.01°before surgery, which improved to 9.33° ± 3.88° at the final follow up (P < 0.05). At the final follow up, there were two patients who had achieved a grade 2 bony fusion (33.3%), three patients grade 3 (50.0%), and one patient grade 4 (16.7%). No incision infections, internal fixation failures or other complica...

Biomechanical characteristics of 2 different posterior fixation methods of bilateral pedicle screws: A finite element analysis

“…If there is a significant lateral bending rotation movement with the participation of torque, the possibility of internal fixation failure is high. [49] Although this difference in stress does not have a decisive impact on the operation, the long-term stress concentration will lead to fracture of pedicle screws due to fatigue, which will bring a series of potential risks after the operation, which is not conducive to the stability of the entire internal fixation system. [50,51] The intervertebral disc is an important load center and buffer structure for spinal function.…”

Open Surgical Treatments of Osteoporotic Vertebral Compression Fractures

“…For example, when there is severe vertebral body comminution or collapse, large fracture fragments may extend into the spinal canal and cause compression of the spinal cord. Treating injuries above the L1 level also carries a higher risk because of the proximity to the spinal cord 17 . Additionally, inadequate anterior support after a posterior distractive reduction for severe collapsed vertebral body may lead to correction failure or implant failure 17 .…”

“…Treating injuries above the L1 level also carries a higher risk because of the proximity to the spinal cord 17 . Additionally, inadequate anterior support after a posterior distractive reduction for severe collapsed vertebral body may lead to correction failure or implant failure 17 . Watanabe et al 12 concluded that, according to the concept of load bearing and load sharing, posterior vertebral fusions can generate posterior stresses through flexion moments in standing or sitting positions, leading to a higher risk of internal fixation failure because of lack of anterior support, and thus longer segmental internal fixation fusions are required.…”

“…It has been shown that anterior decompression of the spinal canal is twice as effective as posterior decompression 26 . Posterior fixation can also be accomplished without damage to the paravertebral muscles 17 . The strength of the fixation in combined approach is superior to that of anterior or posterior surgery alone, especially in patients with severe osteoporosis 26,27 .…”

Effect of Minimally Invasive Internal Arch Nailing Surgery on Tissue Traumatic Stress Response in Patients with Vertebral Fractures

“…Repeated stretching is required during the operation, so the patient will experience muscle ischemic necrosis and a degree of pain in the patient. Obviously, postoperative complications are prone to occur [ 5 ]. In recent years, various minimally invasive techniques have developed rapidly.…”