Background: Osteoporotic thoracolumbar burst fracture (TLBF) is difficult to treat due to its high rate of postoperative implant failure. This study was designed to evaluate the clinical effect of balloon kyphoplasty with polymethylmethacrylate (PMMA) and posterior pedicle screw fixation for the treatment of osteoporotic TLBF.
Methods: Between February 2012 and May 2016, 24 consecutive patients with osteoporotic TLBFs were included in this study, all of whom suffered incomplete neurologic deficit. They were managed with transpedicular balloon kyphoplasty, PMMA augmentation, and posterior pedicle screw fixation. Scanning with X-ray and computed tomography (CT) were performed to evaluate the kyphotic deformity with the Cobb angle and vertebral body height loss (VBHL) of the injured vertebra. Visual analogue scale (VAS) and the Oswestry Disability Index (ODI) were adopted to assess the pain and dysfunction levels before and after the operation.
Results: All participants were followed up for an average of 18 months and those with incomplete neurologic deficit recovered completely. The Cobb angle significantly improved from a preoperative angle of 23.2°±3.6° to 5.3°±2° after operation and to 5.7°±2.2° at the last follow up (P<0.05). The VBHL improved from 56.8%±7.8% before operation to 9.1%±1.6% after operation and to 9.7%±1.9% at the last follow up (P<0.05). The visual analog scale (VAS) score decreased from 8.8±0.9 before operation to 2.5±0.4 after operation and to 1.4±0.4 at the last follow up (P<0.05). The ODI score decreased from 88.6%±3.5% before the operation to 32.3%±3.7% after operation and to 17.5%±1.8% at the last follow up (P<0.05).
Conclusions: Balloon kyphoplasty combined with posterior pedicle screw fixation was an effective treatment for osteoporotic TLBFs. This procedure can reconstruct 3 spinal columns using a single approach with less blood loss, short operation time, and rapid recovery. Ruptures of the posterior vertebral wall should not be a contraindication of this procedure.
Trial registration: Chinese Clinical Trial Registry (NO.: ChiCTR1900026157).
Keywords: Osteoporosis; kyphoplasty; polymethylmethacrylate (PMMA); short-segment fixation; thoracolumbar burst fracture (TLBF).