Reduction of the domino effect in osteoporotic vertebral compression fractures through short-segment fixation with intravertebral expandable pillars compared to percutaneous kyphoplasty: a case control study

Abstract

BackgroundOsteoporotic vertebral compression fracture is the leading cause of disability and morbidity in elderly people. Treatment of this condition remains a challenge. Osteoporotic vertebral compression fractures can be managed with various approaches, but each has limitations. In this study, we compared the clinical outcomes obtained using short-segment fixation with intravertebral expandable pillars (I-VEP) to those obtained with percutaneous kyphoplasty in patients who had suffered vertebral compression fractures.MethodsThe study included 46 patients with single-level osteoporotic thoracolumbar fractures. Twenty-two patients in Group I underwent short-segment fixation with I-VEP and 24 patients in Group II underwent kyphoplasty. All patients were evaluated pre- and postoperatively using a visual analogue scale, anterior height of the fractured vertebra, and kyphotic angle of the fractured vertebra. The latter 2 radiological parameters were measured at the adjacent segments as well.ResultsThere was no significant difference between the groups in terms of gender or fracture level, but the mean age was greater in Group II patients (p = 0.008). At the 1-year follow-up, there were no significant differences in the visual analogue scale scores, anterior height of the fractured vertebra, or the value representing anterior height above the fractured vertebra and kyphotic angle below the fractured vertebra, after adjusting for the patients’ gender, fracture level, and age. When considered separately, the anterior height below the fractured vertebra was significantly higher and the kyphotic angle above the fractured vertebra was significantly smaller in Group I than in Group II (p = 0.029 and p = 0.008, respectively). The kyphotic angle of the fractured vertebra was significantly smaller in Group II than in Group I (p < 0.001).ConclusionsIn older individuals with vertebral compression fractures, kyphoplasty restored and maintained the collapsed vertebral body with less kyphotic deformity than that induced by short-segment fixation with I-VEP. Short-segment fixation with I-VEP was more effective in maintaining the integrity of adjacent segments, which prevented the domino effect often observed in patients with osteoporotic kyphotic spines.

Screw-Related Complications After Instrumentation of the Osteoporotic Spine: A Systematic Literature Review With Meta-Analysis

“…Three studies reported adjacent segment 39,44 or disc degeneration, 33 and only 1 study reported the kyphosis angle proximal to the index level. 41 Since not a single study reported complete information on all the parameters of interest, we attempted to contact all authors to request further information. A total of 4 authors responded to our mails but only 3 were able to provide additional information.…”

“…In 7 studies, screws were augmented, [29][30][31][32][33][34][35] in 21 studies, screws were nonaugmented, 27,28,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] and 4 studies compared outcomes of augmented versus nonaugmented screws. [55][56][57][58] Indications, that is, degenerative disease or fracture, were equally distributed in the studies on augmented and nonaugmented screws (Table 4).…”

Comparison of Outcomes and Complications Among Various Surgical Treatments for Vertebral Compression Fractures: a Retrospective Study.

“…Conservative treatment for compression fractures has not been suggested, as it fails to restore the vertebral body to its origin height. Additionally, pain and spinal deformity are not improved or corrected, and the domino effect follows rapidly after the rst VCF [10]. This effect is a direct consequence of the mechanical variations that affect the spine when physiological curves are modi ed [11].…”

Minimally Invasive Open Reduction and Internal Fixation for Osteoporotic Vertebral Compression Fractures: Technical Report and Mid-Term Outcomes

“…We recently introduced an intra-vertebral expandable pillars (I-VEPs) procedure, and demonstrated that it is effective in reducing collapsed vertebra and in providing fitting fixation for injured vertebra [17]. Posterior short-segment fixation with I-VEPs is an alternative procedure to relieve symptomatic local back pain and avoid a global domino effect in an osteoporotic kyphotic spine [18].…”

“…In other words, cementing should be treated as an augmentation technique and not as a gold standard for the permanent treatment of fractures.I-VEPs are made of titanium alloy due to its excellent biocompatibility and are designed as a hollow threaded cylinder filled with autologous bone graft. After good open reduction with adequate serial dilatation, the biological intra-vertebral body fixation of an I-VEP is used to reconstruct the compressed vertebra through internal mechanical support, and bony fusion is encouraged with enveloped bone chips[17] [18]. PRO-DENSE™, a fully synthetic composite material made from calcium sulphate (CaSO 4 ) and calcium phosphate (CaPO 4 ), is strong composite-like bone cement with good bone regeneration capacity[38]…”