SUMMARY
Aim and object of the study: The vertebral compression fractures (VCF) are one of the most common complication of the osteoporosis that could be a cause for permanent and debilitating pain, restricted mobility and hence significant worsening of the quality of the life. The surgical treatment of the VCF is indicated after a failure of the conservative treatment or after established spinal instability or neurological deficit. The most commonly used surgical procedures are the percutaneous vertebroplasty with poly - methyl methacrylate(PMMA) and the transpedicular screw fixation-reconstruction. The aim of the present investigation is to summarize and elucidate the indications for the different types of spinal techniques, the potential complications and their treatment.
Methods: Analyzed were 72 consecutive patients with compression spinal osteoporotic fractures treated in our clinic from January 2009 to July 2012. Of these, 38 patients (M14 / F24) with average age 66.8 years (54-80) underwent PV on 46 levels. All the fractures were without neurological deficit and classified as A1 type in Magerl. The remaining 34 patients (M5 / F29) with average age 67.3 years (56-85) underwent transpedicular screw spinal reconstruction addressing incomplete burst compression fractures in which were damaged the anterior two columns. A total of 40 levels were addressed The indications for surgery were severe pain syndrome, neurological deficit, presence of bone fragments in the spinal canal or spinal instability.
Results: In our series the VCF most commonly are located in the thoracolumbar (Th11-L2) segment of the spine - 75.6%, (65/86) levels. In 7 patients 2 levels were treated in one settings, 2 patients had 3 levels treated and one patient 4 levels. Our PV subgroup showed very good outcome in 84.2% (32/38) of patients. Due to migration of the cement in the spinal canal, two patients underwent surgical decompression. The results in the spinal instrumentation subgroup are good in 82.4% (28/34) of the cases. In 6 of the instrumented cases a revision surgery had been performed, due to progressing neurological deficit and persistent pain. The surgery addressed screw pull-outs and implant mallposition/displacement.
Conclusion: Our results indicate that modern surgical treatment of osteoporotic patients with symptomatic VCF presents low incidence of complications and allows for a significant reduction of pain, spinal stability, improved quality of life and prolonged active life. PV is minimally invasive procedure with a good effectiveness and uncommon complications that are clinically significant. The spinal instrumented reconstruction is indicated in case of severe multilevel VCF, spinal instability and compression of the neural structures.
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