Efficacy of screw-rod fixation and fusion in revision surgery after vertebroplasty / 中华创伤杂志

ABSTRACT

Objective:To investigate the efficacy of screw-rod fixation and fusion in revision surgery after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty(PKP) for osteoporotic vertebral fractures (OVFs).Methods:A retrospective case series study was carried out on clinical data of 19 patients treated by revision surgery after PVP or PKP at Zhejiang Ningbo No.6 Hospital from January 2014 to December 2017. There were 5 males and 14 females, with age of (70.7±6.0)years (range, 58-81 years). Injured segment was located at T 9 in 1 patient, T 11 in 3, T 12 in 5, L 1 fracture in 5, L 2 in 2, L 3 in 2 and L 4 in 1. Caused for revision and operation methods were as follows, 5 patients underwent debridement, screw-rod fixation and fusion due to infection, 9 patients underwent osteotomy due to progressive kyphosis, screw-rod fixation and fusion, 5 patients underwent spinal canal decompression, screw-rod fixation and fusion due to neurological dysfunction. The operation time, intraoperative blood loss, and perioperative complications were recorded. The white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to evaluate the control of infection before operation, before discharge and at postoperative 3 months. The changes in Cobb angle were measured before and after operation and at the final follow-up. The American spinal injury association (ASIA) scale, visual analog scale (VAS) and Oswestry disability index (ODI) were evaluated at the final follow-up. Results:All patients were followed up for 24-46 months [(32.7±8.3)months]. The revision operation time was 135-320 minutes [(226.3±75.6)minutes]. The intraoperative blood loss was 350-1 500 ml [(825.5±230.6)ml]. There were 1 patient with poor wound healing, 2 with pulmonary infection, and 2 with hardware loosening. The WBC, ESR and CRP decreased from preoperative (9.2±1.7)×10 9/L, (88.7±19.2)mm/h, (58.7±22.9)mg/L to (7.3±0.9)×10 9/L, (42.5±13.7)mm/h, (37.3±16.3)mg/L before discharge, and (6.6±0.7)×10 9/L, (26.8±9.5)mm/h, (17.8±8.6)mg/L at postoperative 3 months ( P<0.01). The Cobb angle improved from preoperative (29.3±5.2)° to (4.8±1.2)° ofter operation and (7.3±1.6)° at the final follow-up ( P<0.05). The patients with ASIA grade C ( n=2) and grade D ( n=1) improved to grade E, and the patients with ASIA grade C ( n=2) improved to grade D at the final follow-up. Imagines showed good bone fusion in all patients at the last follow-up. The mean VAS decreased from preoperative (7.5±0.8)points to (2.1±0.5)points at the last follow-up ( P<0.05). The ODI decreased from preoperative (60.7±15.2)% to (19.9±5.9)% at the last follow-up ( P<0.05). Conclusion:For patients with OVFs undergoing revision surgery after PVP or PKP, debridement, kyphosis correction, spinal canal decompression combined with screw-rod fixation and fusion can reduce infection, correct kyphotic deformity, improve neurological function, relieve pain and improve quality of life.