Percutaneous kyphoplasty combined with pediculoplasty for the surgical treatment of osteoporotic thoracolumbar burst fractures

Abstract

Objective: This study introduces a minimally invasive technique for efficient three-column reconstruction, augmentation, and stabilization of osteoporotic thoracolumbar burst fractures (OTLBFs).

Methods: Sixty-eight patients with OTLBFs and no neurological deficits were included from July 2019 to September 2020. The patients were divided into two groups: the simple percutaneous kyphoplasty (PKP) group (n = 32) and the percutaneous kyphoplasty combined with pediculoplasty (PKCPP) group (n = 36). The clinical and radiological outcomes were assessed during a minimum 1-year follow-up period. Clinical outcomes were assessed via the visual analog scale (VAS) and modified MacNab grading criteria. The radiological outcomes included the Cobb angle (CA), anterior wall height (AWH), and posterior wall height (PWH). The surgery duration, postoperative analgesic dosage, length of hospital stay, and complications were recorded.

Results: Surgery duration was not significantly different between the two groups (P > 0.05). The PKCPP group had a lower analgesic dosage and shorter hospital stay (P < 0.05). Postoperatively, the PKCPP group exhibited better VAS scores and modified MacNab scale scores (P < 0.05), but the differences at the last follow-up assessment were not significant (P > 0.05). Postoperative CA, AWH, and PWH correction were not significantly different on the first postoperative day (P > 0.05). However, the PKCPP group had significantly less CA and PWH loss of correction at the last follow-up visit (P < 0.05). The PKCPP group had significantly fewer complications (P < 0.05).

Conclusions: The PKCPP technique complements simple PKP for OTLBFs. It quickly relieves pain, maintains the vertebral body height and Cobb angle, ensures cement stabilization, and offers more stable three-column support.

Keywords: OVCFs; Osteoporotic thoracolumbar burst fracture; PKCPP; Pediculoplasty; Simple PKP.

Fig. 1

Type A3 fractures are vertebral fractures affecting a single endplate with any involvement of the posterior vertebral wall and spinal canal [36]

Fig. 2

Routine PKP surgery before bone cement injection. a–d Implantation of the puncture needles; e–h the working cannulas were established as follows: i–k The bilateral operating space for the balloon was established; l the balloon was inflated, and the vertebral body height was recovered

Fig. 3

Special operation of the PKCPP surgery, postoperative lateral radiographs, and CT scans. a Making the two working cannulas un-overlapped by slightly adjusting C-arm’s position (blue arrow); b injecting the bone cement of the anterior two-thirds of vertebral body; c–g the procedure of pediculoplasty shows that the cement distribution is columnar shape; h–i intraoperative standard anteroposterior and lateral radiographs show the augmented vertebral body. j–l Postoperative lateral radiographs and CT scans show that the distribution of bone cement is like two pedicle screws bridging the cement-augmented vertebral body

Fig. 4

Clinical results, including the MacNab scale score and mean VAS score for back pain in both groups. The PKCPP group had a greater percentage of patients who met the excellent and good criteria than the simple PKP group at 1 day, 1 month, and 3 months after surgery (P = 0.019, 0.010, and 0.022, respectively); however, the modified MacNab scale score did not significantly differ between the two groups at the last follow-up visit (P = 0.471). The VAS score significantly decreased after surgery in both groups (P < 0.05), and the PKCPP group had better VAS scores than the simple PKP group at 1 day, 1 month, and 3 months after surgery (all P < 0.001); however, the VAS scores in the two groups were not significantly different at the last follow-up visit (P = 0.73)

Fig. 5

AWH, anterior wall height; PWH, posterior wall height; CA, Cobb angle. AWH and PWH were significantly increased on day 1 after surgery in both groups but were slightly lower at the follow-up assessment. Moreover, the PWH loss of correction in the PKCPP group was significantly less than that in the simple group at the last follow-up visit (P < 0.001). The CA was significantly decreased in both groups on day 1 after surgery, but there were no significant differences in the CA (P = 0.71). However, the postoperative CA loss at correction in the PKCPP group was significantly less than that in the simple group at the last follow-up visit (P < 0.05)