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BACKGROUND:Percutaneous vertebroplasty with bone cement injection has the advantages of minimal invasion, short time, effectively restoring vertebral body height, preventing further colapse of the vertebral body and obvious analgesic effect, which has became an effective method for the treatment of elderly osteoporotic compression fractures. OBJECTIVE:To observe the therapeutic effect of percutaneous vertebroplasty with bone cement injection on elderly osteoporotic compression fractures. METHODS:Sixty-two patients with osteoporotic thoracolumbar vertebral compression fracture, including 22 males and 40 females, aged 55-92 years, involving 86 vertebrae, were included and subjected to percutaneous vertebroplasty with polymethyl methacrylate bone cement injection under C-arm X-ray fluoroscopy. During the postoperative folow-up of 12 to 36 months, visual analogue scale scores, Cobb angle and Oswestry disability index scores were compared before and after the treatment. RESULTS AND CONCLUSION: At 12 to 36 months after treatment, there were 11 cases of complications, including 7 cases of bone cement leakage, 2 cases of adjacent vertebral fractures, 1 cases of bone cement tailing and 1 case of unsatisfactory pain relief. In the final folow-up, Cobb angle, visual analogue scale scores, Oswestry disability index scores were significantly improved compared with those before treatment (P < 0.05).These results demonstrate that percutaneous vertebroplasty with polymethyl methacrylate bone cement injection in the treatment of elderly osteoporotic compression fractures can not only restore vertebral shape, reduce kyphosis, reconstruct spinal stability, but also significantly reduce the pain caused by fractures and improve the life quality of patients. The curative effects in short and medium term are positive.
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Objective To investigate the surgical techniques and clinical effects of anterior retropharyngeal approach in treatment of C2/3 fracture and dislocation.Methods Twelve patients with C2/3 fracture and dislocation treated via anterior retropharyngeal approach between November 2011 and April 2013 were included in the study.There were 7 males and 5 females aged from 19 to 65 years (mean,35 years).Primary pathologies included 7 patients with traumatic C3 fracture,2 with Hangman fracture and 3 with fracture and dislocation of the anteroinferior margin of C2 vertebrae.C2-C4 vertebrae were exposed using anterior retropharyngeal approach,followed by C2/3 discectomy or C3 corpectomy,decompression,interbody cage fusion or titanium mesh cage fusion,and anterior internal fixation.Results Exposure of lesion was sufficient for all patients and all operations were completed under direct vision,with mean operation time of 140 minutes and mean blood loss of 120 ml.One patient with reduced tone after operation gradually recovered in a week; one with dysphagia after operation recovered in 3 months; one with skin necrosis 7 days after operation was recovered by changing dressing; for the rest,there were no complications of incision hematoma,infection,or asphyxia.Ten patients were followed up for mean 15 months,which showed bony fusion in mean 6 months.At final follow-up,no implant loosening or displacement occurred.Conclusion Anterior retropharyngeal approach to C2/3 fracture and dislocation provides sufficient exposure of lesions,minor trauma,and less bleedings and complications,but as the local anatomy is complicated,there indeed exists a learning curve of the approach.