Posterior Fixation Combined with Vertebroplasty or Vertebral Column Resection for the Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft Complicated by Neurological Deficits

Abstract

Purpose. The aim of the current study was to evaluate the relative benefits of posterior fixation combined with vertebroplasty (PFVP) or vertebral column resection (PVCR) for osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC) complicated by neurological deficits. Methods. From June 2010 to January 2015, 45 consecutive patients suffering OVCFs with IVC and spinal cord injuries were treated with PFVP or PVCR in our department. The visual analogue scale (VAS) score, anterior vertebral height (AVH), posterior vertebral height (PVH), local kyphotic angle (LKA), and neurologic function were evaluated and compared, and the operative duration, blood loss, and complications were also recorded. Results. They all achieved excellent pain relief, vertebral height recovery, and kyphosis correction one month after surgery, and no significant differences existed between the two groups. No significant differences were observed between the 1-month postoperative and final follow-up VAS, AVH, and LKA values in the PVCR group (P>0.05), while AVH and LKA worsened in the PFVP group at the final follow-up (P<0.05). Similarly, the initial improvements in VAS scores decreased over time (P<0.05). Neurologic function improved in both groups, and no significant differences were observed between the 2 groups either preoperatively or postoperatively (P>0.05). The blood loss and operative duration were significantly lower in the PFVP group than those in the PVCR group (P<0.05). Conclusion. Compared with PVCR, PFVP had equivalent short-term clinical outcomes with less blood loss and operative duration which can be very beneficial for treating elderly patients with extreme comorbidities in this condition. However, based on the long-term efficacy of pain relief, vertebral height maintenance, and deformity correction, PVCR is a more reasonable choice.

Analysis of two minimally invasive procedures for osteoporotic vertebral compression fractures with intravertebral cleft: a systematic review and meta-analysis

“…Owing to the progression of kyphosis with vertebral collapse and intravertebral instability at the cleft site, fractures with IVC are more susceptible to no response to conservative treatment; thus, surgical intervention may be a better choice [9,10]. Open surgery has been described to treat IVC, but it is mainly indicated for patients with neurological deficits [11,12]. Besides, it is inappropriate for most patients with serious comorbidities and severe osteoporosis [13].…”

Intravertebral cleft in pathological vertebral fracture resulting from spinal tuberculosis: a case report and literature review

“…Owing to the progressive kyphosis and intravertebral instability at the cleft site, patients with advanced-stage Kümmell's disease are more susceptible to neurological deficits [19], which is a relative contraindication for cement usage [20]. In recent years, short-segment pedicle screw fixation with polymethylmethacrylate (PMMA) augmentation has been employed for Kümmell's disease complicated by neurological deficits [21][22][23][24], however, some scholars find this procedure may not be supportive enough for the longterm stabilization effect [19]. Therefore, considering serious comorbidities and severe osteoporosis in elderly patients, one-stage posterior osteotomy and fixation is more suitable for treating Kümmell's disease with neurological deficits compared with anterior or anterior and posterior approaches for a long-term effect.…”

“…Therefore, considering serious comorbidities and severe osteoporosis in elderly patients, one-stage posterior osteotomy and fixation is more suitable for treating Kümmell's disease with neurological deficits compared with anterior or anterior and posterior approaches for a long-term effect. Thus, we performed a one-stage posterior vertebral column resection and internal fixation for spinal cord decompression and reconstruction of spinal stability [19,20,25].…”

Total En Bloc Spondylectomy Combined with the Satellite Rod Technique for Spinal Tumors

“…3), and follow-up imaging evaluations were performed every 3 months during the rst year and semiannually thereafter. The AVH, PVH and LKA were assessed before and after surgery, as described in our previous study [16]. The intervertebral titanium mesh cage height (ITMCH) (the height of the fused segments) was measured at the midportion of the adjacent upper and lower endplates after the operation and at the last follow-up.…”