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. 2016:2016:3878063.
doi: 10.1155/2016/3878063. Epub 2016 Aug 10.

Percutaneous Pedicle Screw Fixation with Polymethylmethacrylate Augmentation for the Treatment of Thoracolumbar Intravertebral Pseudoarthrosis Associated with Kummell's Osteonecrosis

Hyeun-Sung Kim  1 , Dong-Hwa Heo  2
Affiliations

Percutaneous Pedicle Screw Fixation with Polymethylmethacrylate Augmentation for the Treatment of Thoracolumbar Intravertebral Pseudoarthrosis Associated with Kummell's Osteonecrosis

Hyeun-Sung Kim et al. Biomed Res Int. 2016.

Abstract

Purpose. The purpose of our study is to evaluate the therapeutic efficacy of short-segment percutaneous pedicle screw fixation with polymethylmethacrylate (PMMA) augmentation for the treatment of osteoporotic thoracolumbar compression fracture with osteonecrosis. Methods. Osteoporotic thoracolumbar compression fractures with avascular necrosis were treated by short-segment PPF with PMMA augmentation. Eighteen were followed up for more than 2 years. The kyphotic angle, compression ratio, visual analog scale (VAS) score for back pain, and the Oswestry Disability Index (ODI) were analyzed. In addition, radiologic and clinical parameters of PPF group were compared with percutaneous vertebroplasty (PVP) group. Results. Vertebral height and kyphotic angle of the compressed vertebral bodies were significantly corrected after the operation (P < 0.05). Further, restored vertebral height was maintained during the 2 or more years of postoperative follow-up. Compared to the PVP group the postoperative compression ratio and kyphotic angle were significantly lower in the PPF group (P < 0.05). The postoperative ODI and VAS of the PVP group were significantly higher than the PPF (P < 0.05). Conclusions. According to our results, short-segment PPF with PMMA augmentation may be an effective minimally invasive treatment for osteoporosis in cases of osteoporotic vertebral compression fractures with Kummell's osteonecrosis.

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Figures

Figure 1
Figure 1
Preoperative MRI and X-ray show a L3 compression fracture with osteonecrosis ((a) and (b)). The compressed L3 body was reexpanded after postural reduction (c). The compressed vertebral body with osteonecrosis was well healed and still restored in spite of left L4 pedicle screw fracture at the 24-month follow-up ((d), (e), and (f)).
Figure 2
Figure 2
Serial changes in the compression ratio (a) and kyphotic angle (b). The PPF group maintained height of the compressed vertebral bodies after the operation compared to the PVP group.
Figure 3
Figure 3
Serial changes in VAS (a) and the ODI (b). The ODI and VAS score of the PVP group are significantly higher than the PPF group at the final follow-up appointment (postoperative 24 months or more).
See this image and copyright information in PMC

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