Article
Occurrence of adjacent segment fractures after surgical treatment of an osteoporotic vertebral fracture – a comparison between two different treatment methods
Auftreten von Anschlussfrakturen nach chirurgischer Versorgung einer osteoporotischen Wirbelkörperfraktur – ein Vergleich zwischen zwei verschiedenen Therapiemethoden
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Published: | June 4, 2021 |
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Objective: Osteoporotic vertebral fractures are a major healthcare problem. A vertebral cement augmentation (VCA) could be used as a minimally invasive surgical approach to manage symptomatic fractures. However, there is a potential risk for an adjacent segment fracture (ASF), which may require second surgery. The addition of transcutaneous screw-fixation with cement-augmentation superior and inferior to the fracture (Hybrid transcutaneous screw-fixation HTSF) may be a good, minimally invasive alternative to reduce the incidence of ASF.
Methods: We have investigated the duration of surgery, hospital stay, intraoperative complication rate and ASF with the need for a surgical therapy in a cohort of 100 consecutive patients receiving either VCA or HTSF in our academic neurosurgical department during the period 2013 to 2018. The median follow-up was 1 year.
Results: During study period, 50 patients received VCA and 50 HTSF. Altogether 68 women (35 VCA; 33 HTSF) and 33 men (15 VCA; 17 HTSF) have been treated. The median-age was 76.5 years (76y VCA; 77 y HTSF). The median duration of surgery was 33.5 min in VCA-group and 99.9 min in the HTSF-group (p < 0.0001). No surgery related complications occurred in the VCA-group with just 1 in the HTSF-group (p = 1). The median hospital stay was 9.5 days in the VCA-group and 11 days in the HTSF-group (p = 0.02). Thirteen patients (26%) in the VCA-group, whereas just four patients (8%) in the HTSF-group developed an adjacent segment fracture in the follow-up (p = 0.031). Ten patients from the VCA-group (10%) und 3 patients (6%) in the HTSF-group received further surgery after the first operation owing to ASF (p = 1).
Conclusion: Based on this single-center cohort, HTSF appears to be a safe and effective option for the treatment of osteoporotic vertebral compression fractures. The duration of surgery was longer than in the HTSF-group, but the rate of ASF can be significantly reduced with the HTSF approach. Further prospective studies are required to address whether HTSF results in a lower revision rate or better postoperative quality of life.
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