Minimally Invasive Fixation in Osteoporotic Vertebral Fractures: A Review Article
Vertebral fracture fixation
Abstract
There are several surgical strategies which have been proposed to treat the osteoporotic patient with vertebral fracture, ranging from vertebral body cement augmentation, percutaneous/mini-open short segment pedicle screw fixation, and cortical bone trajectory screw to kyphotic deformity correction surgery. Minimally invasive spine surgery has the potential benefits of faster recovery, reduced blood loss, less postoperative wound pain, lower infection risk, and shorter length of hospital stay. Novel surgical techniques such as percutaneous instrumentation fixation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation are developed. However, various complications have been reported, including pedicle fracture, instrumentation loosening, adjacent-level disc degeneration with herniation, and progressive junctional kyphosis. The purpose of this review was to outline various advancements in minimally invasive spinal surgery for patients with osteoporosis. Minimally invasive surgical techniques for fixation including percutaneous instrumentation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation have benefited patient with osteoporosis. Studies and discussions about short-segment pedicle screw fixation (one level above and below the fracture level) have shown that it provides enough stability for thoracolumbar burst fractures. There are also complications, including cement embolism, adjacent vertebral fracture, neuraxial anesthesia, and infection, which have been observed with the above technique. With the advancement of instrument and technique, the complication rate decreased in recent studies. Minimally invasive fixation still has many advantages for patients with osteoporosis. Many of these studies and strategies only have evidence from biomechanical and cadaveric studies and require further clinical trials to establish their clinical efficacy.
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PMC8165922].
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14. Silva P, Rosa RC, Shimano AC, Defino HL. Effect of pilot hole on biomechanical and in vivo pedicle screw-bone interface. Eur Spine J. 2013;22(8):1829-36. doi: 10.1007/s00586-013-2810-9. [PubMed: 23653133]. [PubMed Central: PMC3731481].
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16. Hirano T, Hasegawa K, Takahashi HE, Uchiyama S, Hara T, Washio T, et al. Structural characteristics of the pedicle and its role in screw stability. Spine (Phila Pa 1976). 1997;22(21):2504-9. doi: 10.1097/00007632-199711010-00007. [PubMed: 9383856].
17. Kifune M, Panjabi MM, Liu W, Arand M, Vasavada A, Oxland T. Functional morphology of the spinal canal after endplate, wedge, and burst fractures. J Spinal Disord. 1997;10(6):457-66. [PubMed: 9438809].
18. Mikles MR, Stchur RP, Graziano GP. Posterior instrumentation for thoracolumbar fractures. J Am Acad Orthop Surg. 2004;12(6):424-35. doi: 10.5435/00124635-200411000-00007. [PubMed: 15615508].
19. Wu Y, Chen CH, Tsuang FY, Lin YC, Chiang CJ, Kuo YJ. The stability of long-segment and short-segment fixation for treating severe burst fractures at the thoracolumbar junction in osteoporotic bone: A finite element analysis. PLoS One. 2019;14(2):e0211676. doi: 10.1371/journal.pone.0211676. [PubMed: 30716122]. [PubMed Central: PMC6361511].
20. Hu X, Ma W, Chen J, Wang Y, Jiang W. Posterior short segment fixation including the fractured vertebra combined with kyphoplasty for unstable thoracolumbar osteoporotic burst fracture. BMC Musculoskelet Disord. 2020;21(1):566. doi: 10.1186/s12891-020-03576-9. [PubMed: 32825812]. [PubMed Central: PMC7442982].
21. Parker JW, Lane JR, Karaikovic EE, Gaines RW. Successful short-segment instrumentation and fusion for thoracolumbar spine fractures: A consecutive 41/2-year series. Spine (Phila Pa 1976). 2000;25(9):1157-70. doi: 10.1097/00007632-200005010-00018. [PubMed: 10788862].
22. McLain RF, Sparling E, Benson DR. Early failure of short-segment pedicle instrumentation for thoracolumbar fractures. A preliminary report. J Bone Joint Surg Am. 1993;75(2):162-7. doi: 10.2106/00004623-199302000-00002. [PubMed: 8423176].
23. Joshi D, Kakadiya G, Attar U. Time to revisit contraindications of vertebroplasty- A retrospective study of osteoporotic burst fracture operated with vertebroplasty and short segment fixation. N Am Spine Soc J. 2022;10:100111. doi: 10.1016/j.xnsj.2022.100111. [PubMed: 35399202]. [PubMed Central: PMC8987623].
24. Aly TA. short segment versus long segment pedicle screws fixation in management of thoracolumbar burst fractures: Meta-analysis. Asian Spine J. 2017;11(1):150-60. doi:
10.4184/asj.2017.11.1.150. [PubMed: 28243383]. [PubMed Central: PMC5326724].
25. Santoni BG, Hynes RA, McGilvray KC, Rodriguez-Canessa G, Lyons AS, Henson MA, et al. Cortical bone trajectory for lumbar pedicle screws. Spine J. 2009;9(5):366-73. doi: 10.1016/j.spinee.2008.07.008. [PubMed: 18790684].
26. Matsukawa K, Yato Y, Nemoto O, Imabayashi H, Asazuma T, Nemoto K. Morphometric measurement of cortical bone trajectory for lumbar pedicle screw insertion using computed tomography. J Spinal Disord Tech. 2013;26(6):E248-E253. doi: 10.1097/BSD.0b013e318288ac39. [PubMed: 23429319].
27. Radcliff KE, Kepler CK, Jakoi A, Sidhu GS, Rihn J, Vaccaro AR, et al. Adjacent segment disease in the lumbar spine following different treatment interventions. Spine J. 2013;13(10):1339-49. doi: 10.1016/j.spinee.2013.03.020. [PubMed: 23773433].
28. Huang HM, Chen CH, Lee HC, Chuang HY, Chen DC, Chu YT, et al. Minimal invasive surgical technique in midline lumbar inter-body fusion: A technique note. J Clin Neurosci. 2018;55: 103-8. doi: 10.1016/j.jocn.2018.06.033. [PubMed: 30257804].
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| Files | ||
| Issue | Vol 9, No 1 (2023) | |
| Section | Review Article | |
| DOI | https://doi.org/10.18502/jost.v9i1.12563 | |
| Keywords | ||
| Osteoporosis spinal fractures Review minimally Invasive Surgery Bone Cement | ||
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How to Cite
1.
Sie-Hiong T, Ming-Chi K, Yu‑Cheng Y, Meng-Yin H, Fon-Yih T. Minimally Invasive Fixation in Osteoporotic Vertebral Fractures: A Review Article. J Orthop Spine Trauma. 2023;9(1):9-13.
