Severe pathological fractures caused by vertebral hemangiomas with posterior decompression, bone cement augmentation and internal fixation

Abstract

Aim: To evaluate the treatment strategy for pathological fractures caused by vertebral hemangiomas (VHs) using large case series.

Methods: From January 2008 to January 2014, 28 patients suffering from severe pathological fractures (more than 2/3 loss of original vertebral height) due to thoracic or lumbar VHs were randomized to an experimental (the posterior decompression, bone cement augmentation and internal fixation, n=14) or control (only the posterior decompression combined with internal fixation, n=14) group. The anterior, middle vertebral body height, kyphosis angle and the cement leakage were measured on radiography. Visual analogue scale (VAS), 36-item short form (SF-36) and Oswestry disability index (ODI) were recorded to assess the pain relief, life quality and function improvement.

Results: Compared with the preoperation, the anterior, middle vertebral body height and kyphosis angle were significantly improved after two procedures, but the improvement efficacy seemed to be more significant in the experimental group, with no significant loss of correction effect at final follow-up. The VAS, SF-36 and ODI scores were all significantly improved postoperatively, especially at final follow-up in two groups. The neurological situation was improved in patients at least 1 grade in Frankel scale. After mean follow-up of 24 months, no operative complications (internal fixation loosening, breakage, spinal nerve damage or pneumothorax) were observed, except bone cement leakage occurred in two cases in experimental group.

Conclusion: Posterior decompression, bone cement augmentation and internal fixation seems to be effective and safe for pathological fractures caused by VHs, with better outcomes and few complications.

Keywords: Pathological fractures; Pedicle screws fixation; Posterior surgical decompression; Vertebral hemangiomas; Vertebroplasty.