Short-segment posterior instrumentation combined with calcium sulfate cement vertebroplasty for thoracolumbar compression fractures: Radiographic outcomes including nonunion and other complications

Feb 24, 2015Orthopaedics & traumatology, surgery & research : OTSR

Short-segment back support combined with bone cement injection for spine compression fractures: X-ray results including healing problems and other complications

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Abstract

Patients exhibited a significant improvement in anterior vertebral body height from 55.71±15.29% preoperatively to 94.93±5.39% immediately after surgery.

At final follow-up, there was a 6.50±3.89% loss of height correction compared to immediate postoperative measurements.
The local kyphosis angle improved from a mean of 22.23±5.65° preoperatively to 2.67±4.43° immediately after surgery, but reverted to 6.71±4.95° at final follow-up.
The height of the intervertebral disc adjacent to the fractured vertebra increased from 9.87±0.91 mm before surgery to 12.53±0.98 mm after surgery, with a subsequent loss of 2.35±1.15 mm at final follow-up.
Complications included bone nonunion in 7 patients, hardware failure in 2 patients, cement leakage in 9 patients, and disc vacuum phenomenon in 10 patients.
Rapid resorption of calcium sulfate cement may be associated with the observed radiographic outcomes and complications.

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OBJECTIVE: To evaluate the radiographic outcomes of short-segment posterior instrumentation plus vertebroplasty using injectable calcium sulfate cement (CSC) for thoracolumbar compression fractures.

MATERIALS AND METHODS: Twenty-eight patients with a single-level thoracolumbar compression fracture, who underwent short-segment pedicle screw fixation and CSC vertebroplasty, were included in the study. The anterior vertebral body height ratio, local kyphosis angle, and the height of the intervertebral disc adjacent to the fractured vertebra were used to evaluate the radiographic results. Complications including bone nonunion, instrument failure, cement leakage, and disc vacuum formation were also assessed.

RESULTS: The patients were followed up for an average of 24.20±5.40 months. The relative preoperative anterior body height was 55.71±15.29%, which improved to 94.93±5.39% immediately after surgery (P<0.001), and at final follow-up showed a 6.50±3.89% loss of height correction (P<0.001). The mean preoperative local kyphosis angle was 22.23±5.65°, which corrected to 2.67±4.43° immediately after surgery (P<0.001), but reverted to 6.71±4.95° at final follow-up, showing a 4.04±1.91° loss of correction (P<0.001). The mean height of the intervertebral disc proximal to the fractured vertebra was 9.87±0.91 mm before surgery, 12.53±0.98 mm after operation (P<0.001), and the loss of correction at final follow-up was 2.35±1.15 mm with a significant difference compared to immediate postoperative values (P<0.001). Bone nonunion occurred in 7 patients, 2 patients had hardware failure, 9 patients had cement leakage, and 10 patients had disc vacuum phenomenon adjacent to the fractured vertebra.

CONCLUSIONS: The patients who underwent this procedure had a loss of correction of vertebral height and local kyphosis. Complications such as bone nonunion, instrument failure, cement leakage, and disc vacuum may occur. Rapid CSC resorption accounts for these radiographic outcomes and complications.

LEVEL OF EVIDENCE: Level IV, retrospective study.

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Short-segment posterior instrumentation combined with calcium sulfate cement vertebroplasty for thoracolumbar compression fractures: Radiographic outcomes including nonunion and other complications

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