Screw fixation of minimally invasive percutaneous and paraspinal muscle space approach for the treatment of thoracolumbar fractures / 局解手术学杂志

Objective To compare the clinical efficacy of minimally invasive percutaneous pedicle screw fixation and posterior paraspinal muscle space approach pedicle screw fixation for the treatment of thoracolumbar fractures.Methods Retrospectively analyzed the clinical data of 29 patients treated via minimally invasive percutaneous pedicle screw fixation(minimally invasive group) and 28 patients treated via posterior paraspinal muscle space approach pedicle screw fixation(paraspinal muscle approach group) from March 2013 to October 2015.The anterior vertebral height ratio,sagittal Cobb angle,surgical incision,operation time,number of fluoroscopy,intraoperative blood loss and ODI and VAS scores were compared between the two groups.Results All patients were followed up for an average period of 12.6 months (ranged from 6 to 18 months).At the end of 3 days,3 months and 12 months after operation,vertebral sagittal index and Cobb angle of the two groups were significantly recovered compared with the preoperative data(P0.05).The surgical trauma and intraoperative blood loss of patients in the minimally invasive group were significantly lower than those of the paraspinal muscle approach group,while the operation time and fluoroscopy times were significantly higher than those of the paraspinal muscle approach group,and the differences were statistically significant(P<0.05).Conclusion Minimally invasive percutaneous and paraspinal muscle approach pedicle screw fixation are both effective,safe and reliable.Paraspinal muscle approach pedicle screw fixation has shorter operation time and easier operation,while minimally invasive percutaneous pedicle screw fixation has less trauma,less bleeding and faster postoperative recovery.

Predictive Risk Factors for Refracture after Percutaneous Vertebroplasty

OBJECTIVE: To identify risk factors for developing a vertebral refracture after percutaneous vertebroplasty. METHOD: A retrospective analysis of 60 patients who had undergone percutaneous vertebroplasty between January 2008 and April 2010 was conducted. All patients were observed for a 1 year follow-up period, and fracture was defined when it was both clinically reported and radiographically confirmed. Twenty-seven patients with a refractured vertebra and 33 patients without a refracture were included. Of the 60 patients, 20 presented with a refracture from a cemented vertebra, whereas the remaining 40 patients did not. Clinical, imaging and procedure-related factors for each group were analyzed by the Fisher's exact, chi-square, and the Mann-Whitney U-tests. RESULTS: Local kyphotic angle and sagittal index were significant as a result of researching various risk factors related to vertebral refracture (p<0.001, p<0.001, respectively) and refracture from a cemented vertebra itself (p=0.004, p<0.001, respectively). Other factors were not significant. CONCLUSION: Patients who had a high preoperative local kyphotic angle and a high sagittal index required a close follow-up and attention.

Correlation between Progression of Compression and Bone Densiometry Index in Osteoporotic Compression Fracture of Thoracolumbar Spine

PURPOSE: To evaluate whether progression of compression correlates with bone densiometry index in patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine. MATERIALS AND METHODS: Using the results of bone densiometry, 30 patients who were treated conservatively for osteoporotic compression fracture of thoracolumbar spine between March 2002 to March 2005 were categorized into 4 groups; above 80%, 70 to 80%, 60 to 70%, and below 60%. We compared the measurements of sagittal index and anterior vertebral height from the plain radiographs taken at the time of injury and following three consecutive months after the injury. RESULTS: Patients with lower bone densiometry index had greater amount of compression at the time of injury and more rapid progression of compression. We also found that progression of compression was lowest during the first month after injury in all groups. CONCLUSION: Patients with low bone densiometry index in osteoporotic thoracolumbar compression fracture are susceptible to more rapid progression of compression and should have early brace application and longer duration of treatment for osteoporosis.