Pedicle Screw Augmentation Fixation Combined With Interbody Impacted Bone Grafting In The Treatment Of Old Osteoporotic Thoracolumbar Vertebral Fractures With Kyphosis Or Nonunion

Objective:To evaluate the operative effect of pedicle screw augmentation fixation combined with interbody impacted bone grafting in the treatment of old osteoporotic thoracolumbar vertebral fractures with kyphosis or nonunion Methods:Between March 2014 and February 2016,26 patients with old osteoporotic thoracolumbar vertebral fractures with kyphosis or nonunion,who were in accordance with the inclusive criteria were included in the study.The patients with an average age of 67.6±3.5 years(ranged from 62 to 74)all suffered from stubborn lumbar back pain due to single segment lesion.There were 15 patients(5 males and 10 females)in the group of kyphosis only.The injured vertebrae included L2(2 cases);L1(4 cases);T12(5 cases);T11(3 cases)and T7(1 case).3 patients suffered from neurological dysfunction as well as stubborn lumbar back pain.Based on the ASIA classification,1 case was at the level of C and 2 cases were at the level of D.There were 11 patients(3 males and 8 females)in the group of nonunion.The injured vertebrae included L3(1 case);L2(2 cases);L1(4 cases);T12(3 cases)and T11(1 case).5 patients suffered from neurological dysfunction as well as stubborn lumbar back pain.Based on the ASIA classification,2 case was at the level of C and 3 cases were at the level of D.All patients of the two groups were surgically treated by the means of pedicle screw augmentation fixation combined with impacted bone grafting.Then,the effectiveness was evaluated by operation time,blood loss,VAS,ODI,kyphotic Cobb angle and ASIA classification.The operation time and blood loss were compared between the groups of kyphosis only and the nonunion using the independent t-test.The Cobb Angle,VAS score and ODI score between pre-operation and postoperation were compared with paired t test.P<0.05 was considered statistically significant.Results:All cases were followed up for 6 to 12 months(average:9.4±2.1).There were no complications such as bone cement leakage,delayed wound healing,infection,nonfusion,implant failure in both groups.The operation time and blood loss of the Kyphosis only group were 206.5±19.8(146-254min)?874.7±208.7(420-1530 ml)respectively.The nonunion group was 254.8±25.4(171-322 min)? 968.5±216.4(508-1770 ml).There were no significant differences about operation time or blood loss between the two groups(t=5.2,P=0.17)?(t=7.6,P=0.24).The VAS score,ODI score,and kyphotic Cobb angle of the two groups at immediate after operation and at last follow-up were significantly lower than preoperative ones(P<0.05).And that the Cobb angle of all patients had no significant differences in other periods after the surgery(P>0.05).There were no significant differences as to the VAS score,ODI score between 6 months and 12 months after operation.In the group of kyphosis only,1 case recovered from C to E,2 cases from D to E.And in nonunion group,1 case recovered from C to E,another from C to D,and 3 cases from D to E.Conclusions:With the advantages of higher fusion rate,less trauma,convenient deformity correction,reliable fixation and fewer complications,the methods of pedicle screw augmentation fixation combined with interbody impacted bone grafting could be an option in the treatment of old osteoporotic thoracolumbar vertebral fractures with kyphosis or nonunion.