RT Journal Article
T1 Simplified Pedicle Subtraction Osteotomy for Osteoporotic Vertebral Fractures
A1 Plais, Nicolas
A1 Mengis, Charles
A1 Gallego Bustos, Jesus Manuel
A1 Tome-Bermejo, Felix
A1 Peiro-Garcia, Alejandro
A1 Novoa Buitrago, America
A1 Alvarez-Galovich, Luis
K1 pedicle subtraction osteotomy
K1 decancellation technique
K1 osteoporotic vertebral fractures
K1 kyphosis
K1 spine trauma
K1 osteoporosis
K1 spinal instability
K1 complications
K1 Proximal junctional kyphosis
K1 Closing wedge osteotomy
K1 Spinal-fusion
K1 Posterior
K1 Cement
K1 Vertebroplasty
K1 Classification
K1 Collapse
K1 Outcomes
K1 Leakage
AB Background: In osteoporotic vertebral fractures (OVF) involving neurological symptoms and severe kyphosis, vertebral osteotomies are necessary but are associated with a high risk of complications.Methods: We performed a retrospective study. In 14 patients (mean age, 69.3 years old) with unstable thoracolumbar fractures associated with severe kyphosis, a posterior instrumentation with polymethylmethacrylate-augmented screws and a modified pedicle subtraction osteotomy (PSO) at the fracture level were performed to stabilize the spine and correct the kyphosis. The underlying principle behind the osteotomy's technique was to exaggerate the defect caused by the fracture and shorten the spine: (1) completion of a wide laminoforaminotomy, (2) use of successive reamers rotated in the pedicle at a 25 degrees angle in the axial plane to obtain its complete decancellation, (3) insertion of the reamers in a more medial orientation (55 degrees) to collapse the posterior wall, and (4) breakage of the lateral wall. Radiographic and clinical outcomes were analyzed pre- and postoperatively. Complications were reported.Results: Functional scores improved after surgery. Oswestry disability index and visual analog scale scores decreased significantly (33 and 4 points, respectively). Patient satisfaction rate reached 93%. Average postoperative regional vertebral kyphosis was decreased to 3.79 degrees. No dural tear or neurological injuries were observed. Blood loss of 920 mL (+/- 350 mL) and two mechanical complications were reported.Conclusions: OVF can lead to severe deformities. In osteoporotic bones, the use of sequential reamers can simplify the PSO technique, allowing for the shortening and stabilization of the spine without manipulating the dural sac. The risk of neurological injuries and blood loss is decreased.
PB Int soc advancement spine surgery-isass
YR 2021
FD 2021-10-01
LK https://hdl.handle.net/10668/26070
UL https://hdl.handle.net/10668/26070
LA en
DS RISalud
RD Apr 17, 2025