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[Treatment of chronic thoracolumbar osteoporotic fractures combined with kyphosis with cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy].
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Dec 15; 34(12):1533-1538.ZX

Abstract

Objective

To evaluate the effectiveness of cement-injectable cannulated pedicle screw combined with multiple level Schwab grade Ⅰ osteotomy for chronic thoracolumbar osteoporotic fractures with kyphosis.

Methods

The clinical data of 27 patients with symptomatic chronic thoracolumbar osteoporotic fractures combined with kyphosis treated between June 2015 and June 2017 were retrospectively analysed. Among them, there were 8 males and 19 females, with an average age of 69.5 years (range, 56-81 years). The damage segment (kyphosis vertex) included T 11 in 4 cases, T 12 in 12 cases, L 1 in 10 cases, and L 2 in 1 case. The disease duration ranged from 3 to 21 months, with an average of 12.5 months. The T value of lumbar vertebral bone mineral density ranged from -4.9 to -2.5, with an average value of -3.61. The American Spinal Injury Association (ASIA) classification was used to evaluate spinal cord injury, there were 1 case of grade D and 26 cases of grade E. The visual analogue scale (VAS) score, Oswestry disability index (ODI), kyphosis Cobb angle of fracture site, and sagittal vertical axis (SVA) data were obtained before operation, at 2 weeks after operation, 3 months after operation, and last follow-up, to evaluate the quality of life and improvement of sagittal spine parameters.

Results

No complications related to pedicle screw and bone cement occurred. The incisions healed by first intention in 26 cases, and 1 incision healed after dressing change due to poor blood glucose control. There were no complications such as bedsore, hypostatic pneumonia, or deep venous thrombosis. All patients were followed up 8-24 months, with an average of 16.6 months. The VAS score, ODI score, Cobb angle, and SVA were significantly improved when compared with those before operation (P<0.05). There was no significant difference in Cobb angle between each time point after operation (P>0.05); the VAS score and ODI score at 3 months after operation and last follow-up were significantly better than those at 2 weeks after operation (P<0.05), and the ODI score at last follow-up was further improved when compared with the score at 3 months (P<0.05), but there was no significant difference in VAS score (P>0.05); SVA at last follow-up was significantly worse than that at 2 weeks and 3 months after operation (P<0.05), but there was no significant difference between at 2 weeks and 3 months after operation (P>0.05). During the follow-up period, there was no complication such as pedicle screw loosening, breakage or cutting, adjacent vertebral fracture, proximal junctional kyphosis, and so on.

Conclusion

For the chronic thoracolumbar osteoporotic fractures combined with kyphosis, the cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy has the advantages of less operation trauma, quick recovery, and remarkable effectiveness.

Authors+Show Affiliations

Department of Spinal Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 450000, P.R.China;Department of Orthopedics, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen Guangdong, 518033, P.R.China.Department of Spinal Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 450000, P.R.China.Department of Spinal Surgery, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Zhengzhou Henan, 450000, P.R.China.Department of Orthopedics, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen Guangdong, 518033, P.R.China.Department of Orthopedics, the Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen Guangdong, 518033, P.R.China.

Pub Type(s)

Journal Article

Language

chi

PubMed ID

33319531

Citation

Zhang, Di, et al. "[Treatment of Chronic Thoracolumbar Osteoporotic Fractures Combined With Kyphosis With Cement-injectable Cannulated Pedicle Screw and Multiple Level Schwab Grade Ⅰ Osteotomy]." Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chinese Journal of Reparative and Reconstructive Surgery, vol. 34, no. 12, 2020, pp. 1533-1538.
Zhang D, Zhang W, Zhou X, et al. [Treatment of chronic thoracolumbar osteoporotic fractures combined with kyphosis with cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020;34(12):1533-1538.
Zhang, D., Zhang, W., Zhou, X., Shen, H., & Jin, S. (2020). [Treatment of chronic thoracolumbar osteoporotic fractures combined with kyphosis with cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi = Zhongguo Xiufu Chongjian Waike Zazhi = Chinese Journal of Reparative and Reconstructive Surgery, 34(12), 1533-1538. https://doi.org/10.7507/1002-1892.202006129
Zhang D, et al. [Treatment of Chronic Thoracolumbar Osteoporotic Fractures Combined With Kyphosis With Cement-injectable Cannulated Pedicle Screw and Multiple Level Schwab Grade Ⅰ Osteotomy]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Dec 15;34(12):1533-1538. PubMed PMID: 33319531.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Treatment of chronic thoracolumbar osteoporotic fractures combined with kyphosis with cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy]. AU - Zhang,Di, AU - Zhang,Wenming, AU - Zhou,Xianwei, AU - Shen,Huiyong, AU - Jin,Song, PY - 2020/12/15/entrez PY - 2020/12/16/pubmed PY - 2020/12/17/medline KW - Cement-injectable cannulated pedical screw KW - Schwab gradeⅠosteotomy KW - kyphosis KW - osteoporosis KW - thoracolumbar fracture SP - 1533 EP - 1538 JF - Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery JO - Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi VL - 34 IS - 12 N2 - Objective: To evaluate the effectiveness of cement-injectable cannulated pedicle screw combined with multiple level Schwab grade Ⅰ osteotomy for chronic thoracolumbar osteoporotic fractures with kyphosis. Methods: The clinical data of 27 patients with symptomatic chronic thoracolumbar osteoporotic fractures combined with kyphosis treated between June 2015 and June 2017 were retrospectively analysed. Among them, there were 8 males and 19 females, with an average age of 69.5 years (range, 56-81 years). The damage segment (kyphosis vertex) included T 11 in 4 cases, T 12 in 12 cases, L 1 in 10 cases, and L 2 in 1 case. The disease duration ranged from 3 to 21 months, with an average of 12.5 months. The T value of lumbar vertebral bone mineral density ranged from -4.9 to -2.5, with an average value of -3.61. The American Spinal Injury Association (ASIA) classification was used to evaluate spinal cord injury, there were 1 case of grade D and 26 cases of grade E. The visual analogue scale (VAS) score, Oswestry disability index (ODI), kyphosis Cobb angle of fracture site, and sagittal vertical axis (SVA) data were obtained before operation, at 2 weeks after operation, 3 months after operation, and last follow-up, to evaluate the quality of life and improvement of sagittal spine parameters. Results: No complications related to pedicle screw and bone cement occurred. The incisions healed by first intention in 26 cases, and 1 incision healed after dressing change due to poor blood glucose control. There were no complications such as bedsore, hypostatic pneumonia, or deep venous thrombosis. All patients were followed up 8-24 months, with an average of 16.6 months. The VAS score, ODI score, Cobb angle, and SVA were significantly improved when compared with those before operation (P<0.05). There was no significant difference in Cobb angle between each time point after operation (P>0.05); the VAS score and ODI score at 3 months after operation and last follow-up were significantly better than those at 2 weeks after operation (P<0.05), and the ODI score at last follow-up was further improved when compared with the score at 3 months (P<0.05), but there was no significant difference in VAS score (P>0.05); SVA at last follow-up was significantly worse than that at 2 weeks and 3 months after operation (P<0.05), but there was no significant difference between at 2 weeks and 3 months after operation (P>0.05). During the follow-up period, there was no complication such as pedicle screw loosening, breakage or cutting, adjacent vertebral fracture, proximal junctional kyphosis, and so on. Conclusion: For the chronic thoracolumbar osteoporotic fractures combined with kyphosis, the cement-injectable cannulated pedicle screw and multiple level Schwab grade Ⅰ osteotomy has the advantages of less operation trauma, quick recovery, and remarkable effectiveness. SN - 1002-1892 UR - https://www.unboundmedicine.com/medline/citation/33319531/[Treatment_of_chronic_thoracolumbar_osteoporotic_fractures_combined_with_kyphosis_with_cement_injectable_cannulated_pedicle_screw_and_multiple_level_Schwab_grade_Ⅰ_osteotomy]_ L2 - http://www.diseaseinfosearch.org/result/4058 DB - PRIME DP - Unbound Medicine ER -