The Combination Of Postural Reduction, Percutaneous Pedicle Screw Fixation And Percutaneous Vertebroplasty In The Treatment Of Thoracolumbar Burst Fractures In The Elderly

Objectives: Thoracolumbar vertebral fractures occurr more easily than other segments of the spine due to the special anatomical structure and biomechanical characteristics of the thoracolumbar spine.In addition,because of osteoporosis,only slight violence will cause thoracolumbar burst fracture among those elderly people.The burst fracture pieces of the posterior wall of the vertebral body often penetrate into the spinal canal,which causing damage of nerve,even leading to paralysis.For patients with nerve injury,most scholars advocate surgical treatment,but there are still a lot of controversy on how to treat patients with no nerve injury.The purpose of this study was to investigate the feasibility of postural reduction and percutaneous pedicle screw fixation combined with Percutaneous Vertebroplasty in the treatment of thoracolumbar burst fractures in the elderly,aiming to provide a feasible solution for the treatment of senile thoracolumbar burst fracture.Methods:This paper collected 23 elderly patients above 60 years old who carried with thoracolumbar burst fracture,visiting the department of orthopedics of Wuhan hospital of Traditional Chinese Medicine during March 2013 to March 2015.There was no spinal cord injury and burst fracture pieces of the posterior wall of the vertebral body penetrating into the spinal canal.All cases were routinely treated with X-ray,CT scan and MRI scan of the thoracic and lumbar vertebrae.After actively treating underlying diseases,and the body conditions allowing,the doctor put the patient in the prone position on the lumbar pad,to extend the thoracic lumbar spine by the gravity of the natural sinking of the abdomen,treating the patients with thoracolumbar percutaneous short segmental pedicle screw fixation combined with transpedicular vertebral bone cement injection.Record the operation time,bleeding volume,bone cement injection volume,time of getting out of the hospital bed,VAS score of preoperative postoperative 24 hours,vertebral compression rate,Cobb angle of sagittal position,rate of the burst frature pieces accounting for vertebral canal,grade of ASIA,ODI index and so on.Observe postoperative complications of the patients.All the data were statistically analyzed with SPSS 17 software before and after operation.The measurement data were expressed by mean plus or minus standard deviation,and the data were compared by t test before and after treatment.The significant level was P<0.05.Results:The operation time was 101.12±18.77(90-132)minutes,bleeding 80.39±27.23(50-135)ml,bone cement injection amount 2.25±0.21(2-3)ml,average time of getting out of the hospital bed of 5 days.Patients were followed up for 12 ~ 15 months(average 13.12 months),satisfactorily recovered fracture of the vertebral body.Preoperative VAS score was 8.35±1.91,postoperative VAS score was 2.12 ± 0.46;Preoperative anterior and posterior vertebral compression rate was respectively(50.24 + 6.07)% and(19.22 + 3.55)%,postoperative anterior and posterior vertebral compression rate was respectively(18.98 + 2.87)% and(3.99 + 0.98)%;The sagittal Cobb angle changed from preoperative 16.32°±2.17° to 5.74°±1.64°,averagely corrected 10.56 degrees;preoperative occupying rate was(27.97 + 2.78)%,postoperative occupying rate was(8.46 + 2.03)%;ODI before operation was(59.68 + 8.33)% and after surgery(28.55 + 3.72)%;All 23 cases were grade E of ASIA before operation,and the same after operation,indicating that no nerve injury before or after operation.There was no postoperative complications,no significant loss of vertebral height,no collapse of intervertebral space,no bending or loosening of internal fixation of fracture.Conclusions:The combination of Postural reduction,posterior percutaneous pedicle screw fixation and Percutaneous Vertebroplasty can quickly improve the pain,stability of vertebral injury,reconstruction of spinal stability,allow patients active early.This kind of combined surgery will not need a blood transfusion and large incision,and is an effective method in treatment of elderly patients with thoracolumbar burst fracture.In order to avoid the increase of pressure inside the bone,the operator must stop inject bone cement as it is getting close to the posterior margin of the vertebral body during operation.