The 'armed concrete' approach: stent-screw-assisted internal fixation (SAIF) reconstructs and internally fixates the most severe osteoporotic vertebral fractures

Abstract

BackgroundThe treatment of severe osteoporotic vertebral compression fractures (VCFs) with middle-column (MC) involvement, high fragmentation, large cleft and/or pedicular fracture is challenging. Minimally invasive 'stent-screw-assisted internal fixation' (SAIF) can reduce the fracture, reconstruct the vertebral body (VB) and fix it to the posterior elements.ObjectiveTo assess feasibility, safety, technical and clinical outcome of the SAIF technique in patients with severe osteoporotic VCFs.Methods80 treated vertebrae were analyzed retrospectively. Severe VCFs were characterized by advanced collapse (Genant grade 3), a high degree of osseous fragmentation (McCormack grade 2 and 3), burst morphology with MC injury, pediculo-somatic junction fracture, and/or large osteonecrotic cleft. VB reconstruction was evaluated on postprocedure radiographs and CT scans by two independent raters. Clinical and radiological follow-ups were performed at 1 and 6 months.ResultsSAIF was performed at 28 thoracic and 52 lumbar levels in 73 patients. One transient neurological complication occurred. VB reconstruction was satisfactory in 98.8% of levels (inter-rater reliability 96%, κ=1). Follow-up at 1 month was available for 78/80 levels and at 6 months or later (range 6–24, mean 7.9 months) for 73/80 levels. Significant improvement in the Visual Analog Scale score was noted at 1 and 6 months after treatment (p<0.05). Patients reported global clinical benefit during follow-up (Patient’s Global Impression of Change Scale 5.6±0.9 at 1 month and 6.1±0.9 at 6 months). Fourteen new painful VCFs occurred at different levels in 11 patients during follow-up, treated with vertebral augmentation or SAIF. Target-level stability was maintained in all cases.ConclusionsSAIF is a minimally invasive, safe, and effective treatment for patients with severe osteoporotic VCFs with MC involvement.

Expandable Intravertebral Implants: A Narrative Review on the Concept, Biomechanics, and Outcomes in Traumatology

“…Cement leakage was detected in 10% of cases on postprocedure CT, with an epidural or foraminal location in 3.8%, without clinical relevance. The authors concluded that the SAIF technique is a feasible, safe, and effective minimally invasive procedure of internal stabilization for severe osteoporotic vertebral compression fractures with middle column involvement [55]. As for SpineJack®, a pioneering comparative randomized prospective study in 300 patients with osteoporotic compression fractures type A1 of the AO Spine classification demonstrated that the group that underwent the application of SpineJack® obtained a significantly higher restoration of the vertebral body height than kyphoplasty, with both clinical and functional outcomes similar between the two techniques [19].…”

“…Distefano et al applied the stent-screw-assisted internal fixation to reduce vertebral compression fractures, reconstruct the vertebral body, and fix it to the posterior elements by a technique previously described by the same group [ 49 , 55 ]. The technique rationale is that the stents obtain and maintain fracture reduction while the pedicle screws anchor the VBS-cement complex to the posterior elements, avoiding its displacement, and act as a bridge across the middle column, preserving its integrity from possible collapse and splitting [ 49 ].…”

“…Cement leakage was detected in 10% of cases on postprocedure CT, with an epidural or foraminal location in 3.8%, without clinical relevance. The authors concluded that the SAIF technique is a feasible, safe, and effective minimally invasive procedure of internal stabilization for severe osteoporotic vertebral compression fractures with middle column involvement [ 55 ].…”

Vertebroplasty, Kyphoplasty, and Implant-Based Mechanical Vertebral Augmentation

“…Increasingly complex osteoporotic and traumatic fractures with severe kyphosis, burst morphology with middle column and posterior column (PC) involvement, and nonunions all can lead to progressive collapse. 57 In these more severe and high-risk morphologies, failure of VA can occur with distraction of fragments, resulting in severe kyphosis, development of neurologic symptoms, and the need for surgical revision.…”

Stentoplasty with Resorbable Calcium Salt Bone Void Fillers for the Treatment of Vertebral Compression Fracture: Evaluation After 3 Years

“… 7 , 8 In recent years, a new minimally invasive technique, called Stent-Screw Assisted Internal Fixation (SAIF), was developed based on the VBS system and can be applied in severe neoplastic and osteoporotic fractures. 9 , 10 It has good clinical efficacy and biomechanical support. 11 , 12 The VBS/PMMA can effectively reconstruct the load-bearing capacity of the anterior column.…”