Minimally Invasive Pedicle Screw Fixation, Including the Fractured Vertebra, Combined with Percutaneous Vertebroplasty for Treatment of Acute Thoracolumbar Osteoporotic Compression Fracture in Middle-Age and Elderly Individuals

Background: To evaluate the feasibility, efficacy, and safety of minimally invasive pedicle screw (MIPS) fixation, including the fractured vertebra, combined with percutaneous vertebroplasty (PVP) for the treatment of acute thoracolumbar osteoporotic compression fracture in middle-age and elderly individuals.Methods: Between January 2016 and August 2019, a total of 30 patients, with a mean age of 69.4 years (range, 58–75 years), who experienced thoracic or lumbar fracture without neurological deficits, underwent the MIPS procedure combined with PVP. Preoperative and postoperative pain were assessed using a visual analog scale (VAS) and Oswestry Disability Index (ODI). Cobb angles and anterior column height were measured on lateral radiographs before surgery and at 3 days, 1, 3, and 6 months, and 1 and 2 years at final follow-up after surgery.Results: All patients underwent surgery successfully, with a mean follow-up of 18.2 ± 5.7 months (range, 12–45 months). Mean preoperative VAS score decreased from 7.3±2.2 to 1.4±0.3 at the final follow-up (p<0.05). Mean preoperative ODI decreased from 84.2±10.3 to 18.8±7.5 (p<0.05) at the final follow-up. The Kyphosis angle of operative segment was improved from preoperative (21.38±1.68)° to(4.01 ± 1.38)°3 days postoperatively and(5.02±1.09)°at final follow up (p<0.05).The anterior vertebral height was improved from preoperative(49.86±6.50)% to(94.01±1.79)% 3 days postoperatively and (91.80±1.88)% at final follow up (p<0.05). No significant changes in vertebral body height restoration were observed during 2 years of follow-up after surgery. In addition, there were no instrumentation failures or complications in any of the patients.Conclusions: MIPS, including the fractured vertebra, combined with PVP, was a reliable and safe procedure, with satisfactory clinical and radiological results for the treatment of thoracolumbar osteoporotic compression fracture in patients without neurological deficits.

Effectiveness of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture

Background Percutaneous kyphoplasty is the main method in the treatment of thoracolumbar osteoporotic compression fractures. However, much radiation exposure during the operation harms the health of surgeons and patients. In addition, the accuracy of this surgery still needs to be improved. This study aimed to assess the radiation exposure and clinical efficacy of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture. Methods Included in this retrospective cohort study were 60 patients (60–90 years) who had undergone unilateral vertebroplasty for thoracolumbar osteoporotic compression fracture at our hospital between June 2019 and June 2020. All showed no systemic diseases and were assigned to Tirobot group (treated with Tirobot-assisted approach) and control group (treated with traditional approach). Fluoroscopic frequency, operative duration, length of stay (LOS), post-operative complications (cement leakage, infection, and thrombosis), and pre-operative and pre-discharge indexes (VAS score, JOA score, and Cobb’s angle) were compared. Results The fluoroscopic frequency (P < 0.001) and post-operative complications (P = 0.035) in Tirobot group were significantly lower than those in control group. The operative duration and LOS in the Tirobot group were shorter than those in the control group, but the differences were not statistically significant (P = 0.183). Pre-discharge VAS score and Cobb’s angle decreased, and JOA increased after surgeries in both groups. These three indexes showed a significant difference after surgery in each group (P < 0.001), but not between groups (PVAS = 0.175, PCobb’s = 0.585, PJOA = 0.448). Conclusion The Tirobot-assisted vertebroplasty can reduce surgery-related trauma, post-operative complications, and patients’ and operators’ exposure to radiation. As a safe and effective strategy, this surgery can realize the quick recovery from thoracolumbar osteoporotic compression fracture.

Effectiveness of Tirobot-assisted Vertebroplasty in Treating Thoracolumbar Osteoporotic Compression Fracture

Background: Percutaneous kyphoplasty is the main method for the treatment of thoracolumbar osteoporotic compression fractures. However, much radiation exposure during the operation could harm the health of the surgeon and the patient. In addition, the accuracy of its surgery still needs to be improved. This study aimed to assess the radiation exposure and clinical efficacy of Tirobot-assisted vertebroplasty in treating thoracolumbar osteoporotic compression fracture.Methods: A total of 60 patients with thoracolumbar osteoporotic compression fracture who underwent unilateral vertebroplasty at our hospital between June 2019 and June 2020 were included in this retrospective cohort study. All of them were between 60 and 90 years old and free of systemic diseases. All the patients were assigned to Tirobot group (treated with Tirobot-assisted approach) and control group (treated with traditional approach). Fluoroscopic frequency, operative duration, length of stay (LOS), post-operative complications (cement leakage, infection, and thrombosis), pre-operative and pre-discharge indexes (VAS scores, JOA scores, and Cobb’s angles) were compared.Results: The fluoroscopic frequency(P<0.001), post-operative complications(P=0.035) in Tirobot group was significantly lower than those in control group. The operative duration and LOS in Tirobot group were shorter than those in control group, but the differences were not statistically significant (P=0.183). Pre-discharge VAS score and Cobb’s angle decreased, and JOA increased after surgeries in both groups. These three indexes showed significant differences after surgery in each group (P<0.001), but not between groups (PVAS=0.175, PCobb’s=0.585, PJOA =0.448).Conclusion: As a safe and effective strategy, Tirobot-assisted vertebroplasty can reduce radiation exposure and be clinically replicated.

The Effectiveness of the Amount of Polymethylmethacrylate In The Treatment of Osteoporotic Compression Fracture of The Lumbar Vertebrae

Objective: We aimed to investigate the effectiveness of the amount of polymethylmethacrylate used in pain control and maintenance of long-term vertebra corpus height in patients undergoing percutaneous vertebroplasty due to osteoporotic compression fracture of the lumbar vertebra. Method: A total of 60 patients who underwent unilateral percutaneous vertebroplasty between 2014 and 2019 due to osteoporotic compression fracture of the lumbar vertebrae were included in the study. Patients who received 5 ml and 3 ml cement injection were retrospectively analyzed. Of patients, postoperative visual analogue scale (VAS) score and anterior vertebral height of the patients at 1st-year control were evaluated. Results: In the postoperative period, the mean visual analogue scale score was 2.3±0.46 in the 5 ml injected group and 2.2±0.4 in the 3 ml injected group (p5 ml=0.001, p3 ml= 0.001). There was a statistically significant decline in pain control in both groups. The mean anterior vertebral height loss (AVHL) in the 5 ml injected group was 31.5±0.40%, and 32.6±0.47% in the 3 ml injected group (p5 ml=0.820, p3ml= 0.870). There was no statistically significant alteration in both groups. Conclusion: Our results indicate that the 3 ml polymethylmethacrylate injection during the percutaneous vertebroplasty procedure provides adequate pain control and stabilization in patients with lumbar vertebral osteoporotic fracture. Therefore we think that small amount of polymethylmethacrylate (3 ml) is sufficient to avoid undesirable complications in this patient group.