Vertebroplasty combined with transpedicular fixation for the management of non-traumatic osteoporotic vertebral fractures associated with pedicle fractures

Abstract

Objective: Non-traumatic osteoporotic vertebra fracture (OVF) in association with bilateral pedicle fracture (PD) is a rare condition. In particular, OVFs demonstrating vacuum cleft sign and superior endplate discontinuity extending to the posterior cortex may be associated with non-traumatic PDs. This coexistence results in an unstable fracture pattern, and when solely treated with vertebroplasty (VP), vertebral collapse develops, leading to dead bone formation. We aimed to evaluate the efficacy of VP combined with transpedicular fixation (TPF) for the management of OVFs associated with PD. Materials and Methods: Patients treated with VP combined with percutaneous TPF with a fenestrated screw at the same level of OVF were included. Prophylactic VP was performed at one level above and below. All patients underwent magnetic resonance imaging (MRI) and computerized tomography (CT) during preoperative evaluation. Preop and postop CT scans used for vertebral height measurements and comparison. Results: Thirty-two pts (10M, 22F), mean age 74 (47-92) years of OVF and f/up 30 (24-74) months. Quantative-CT analysis including bone mineral density and t-score mean values was 56.79 mg/cm3 and -4.38±0.538 respectively. VP combined with TPF was performed at 21 pts (Thoracolumbar), 8 pts (Thoracic), and 3 pts (Lumbar spine). Prophylactic VP was performed at 87 levels. The mean vertebral body angle improvement was 20.9% and the mean local kyphosis angle improvement was 17.2%. The mean anterior vertebral height and posterior vertebral height increased by 13.5% and 3.5%, respectively. None of the pts developed further vertebral collapse and none the pedicle screws pulled out at the final f/up. Conclusion: According to our study, VP combined with TPF provided stable fixation and prevented further vertebral collapse in patients with OVF associated with pedicle fractures. OVF with a vacuum cleft sign or superior endplate discontinuity extending to the posterior cortex must be evaluated for the coexistence of spontaneous pedicle fracture, which causes instability and vertebral collapse. We recommend routine preoperative CT scan evaluation to determine fracture pattern and check pedicle integrity in addition to MRI scans.