ObjectiveTo explore the therapeutic effects and clinical characteristics of repeated percutaneous vertebroplasty (PVP) on subsequent non-operative osteoporotic vertebral compressible fractures (OVCF) after initial PVP for OVCF. MethodsFrom January 2008 to May 2013, 277 patients (331 vertebral bodies) with OVCF who were regularly followed up had underwent PVP. Among the 277 patients, the second treatment group included 42 patients who developed subsequent OVCF, which were retreated by PVP. And they were divided into adjacent new OVCF group (group A, 19 patients) and non-adjacent new OVCF group (group B, 23 patients). Analgesic effects and functional improvements were compared between the initial and second treatment. The interval of new OVCF after initial surgery, complications, and other clinical characteristics including age, gender, history of trauma, the amount of injected polymethylmethacrylate (PMMA) and PMMA leakage were compared between group A and B. ResultsThe improvement rates of visual analogue scale scores were (64.6±12.6)% in the initial treatment group and (67.4±12.8)% in the second treatment group (P>0.05). The improvement rates of Oswestry Disability Index (ODI) were (60.6±13.3)% in the initial treatment group and (62.6±12.9)% in the second treatment group (P>0.05). The interval of incidence of subsequent new OVCF after the initial treatment were (62.4±45.5) days in group A and (203.7±77.6) days in group B, respectively (P<0.05). There were no significant differences in age, gender, history of trauma, the amount of injected PMMA and PMMA leakage between group A and group B (P>0.05). No surgery-related complications occurred after the second treatment except asymptomatic cement leakage in 5 patients, one of whom suffered from adjacent OVCF 3 months after the operation. ConclusionThe therapeutic effect of repeated PVP for new OVCF on alleviating the pain and improving the function is just as the effect of the initial operation. Adjacent new OVCF primarily occurs earlier after initial PVP.
ObjectiveTo investigate the short-term effectiveness of balloon vertebroplasty combined with short-segment pedicle screw instrumentation for the treatment of thoracolumbar burst fractures. MethodsBetween June 2011 and December 2013, 22 patients with thoracolumbar burst fractures were included. There were 14 males and 8 females, aged 20-60 years (mean, 42.5 years). The fracture segments included T11 in 1 case, T12 in 4 cases, L1 in 10 cases, L2 in 6 cases, and L3 in 1 case. According to AO classification system, there were 13 cases of type A and 9 cases of type B. Spinal cord injury was classified as grade C in 2 cases, grade D in 3 cases, and grade E in 17 cases according to Frankel scale. The time from injury to operation was 3-10 days (mean, 5.5 days). All patients underwent posterior reduction and fixation via the injured vertebra, transpedicular balloon reduction of the endplate and calcium sulfate cement (CSC) injection. The ratio of anterior vertebral height, the ratio of central vertebral height, the sagittal Cobb angle, the restoration of nervous function, and internal fixation failure were analyzed. ResultsPrimary healing of incision was obtained in the others except 2 cases of poor healing, which was cured after dressing change or debridement. All the patients were followed up 9-40 months (mean, 15 months). CSC leakage occurred in 2 cases. Absorption of CSC was observed at 8 weeks after operation with complete absorption time of 12-16 weeks (mean, 13.2 weeks). The mean fracture healing time was 18.5 weeks (range, 16-20 weeks). The ratio of anterior vertebral height, ratio of central vertebral height, and sagittal Cobb angle were significantly improved at 1 week and 3 months after operation and last follow-up when compared with preoperative values (P<0.01), but no significant difference was found among 3 time points after operation (P>0.01). There was no internal fixation failure or Cobb angle loss more than 10°. Frankel scale was improved with no deterioration of neurologic function injury. ConclusionBalloon vertebroplasty combined with short-segment pedicle screw instrumentation is simple and safe for the treatment of thoracolumbar burst fractures, and it can improve the quality of reduction, restore vertebral mechanical performance effectively, and prevent the loss of correction and internal fixation failure.