Presented here is a modified procedure for minimally invasive injections of bone cement to treat osteoporotic spinal fractures in elderly patients.
The minimally invasive injection of bone cement (MIIBC) is an effective way to treat senile osteoporotic spinal fractures (OSF) in clinical practice. However, the intraspinal dura and nerves may be damaged when the puncture needle passes through the pedicle. Therefore, in this protocol, the puncture site was optimized during the surgery, selecting the same 1-2 cm away from the surface projection of the diseased vertebra. The needle was punctured along the lateral cortex of the pedicle from the junction of the pedicle and the vertebral body into the vertebral body. Meanwhile, bone cement was used as a filling material, and the MIIBC was performed by a percutaneous puncture at the external edge of the pedicle under C-arm fluoroscopy. This modified puncture site is far away from the spinal canal as possible, thereby reducing the risk of the puncture needles penetrating the spinal canal and damaging the nerves and dura mater. In conclusion, a modified MIIBC by percutaneous lateral pedicle puncture can effectively relieve pain in elderly patients with OSF.
Osteoporosis is a common disease among middle-aged and elderly women. Statistics show that about 54% of postmenopausal women have abnormal bone density, and the chance of vertebral fracture over the age of 50 is about 32%1. Osteoporotic spinal fractures (OSF) occur most commonly in women and are mainly compression fractures caused by direct or indirect external forces1,2. After the fracture, the sagittal balance of the spine is broken, resulting in vertebral deformation, diffuse lumbar and back pain, and kyphosis2. In addition, some patients also experience abdominal pressure and breathing difficulties3. Clinical trials have reported that the key to the treatment of OSF is the restoration of bone continuity4. Without effective and timely treatment for OSF patients, it is easy for spinal deformities, secondary nerve injury, spinal canal stenosis, angulation deformity, delayed fracture healing, and bone nonunion to occur, and the lives of the patients may even be threatened5.
Current clinical treatments for OSF include conservative treatment and surgical treatment6. Although the conservative treatment of OSF can provide temporary relief of the symptoms, the course of treatment is long, and the recovery of the injured vertebral height is poor7. Overall, the traditional conservative treatment of OSF requires patients to stay in bed for a long time, and its overall efficacy is not ideal. For now, clinical, surgical treatment for OSF embraces traditional open internal fixation, Sextant minimally invasive pedicle screw fixation, percutaneous vertebroplasty (PVP), and percutaneous kyphoplasty (PKP)8. Similar to the conservative treatment of long-term bed rest, traditional open internal fixation can lead to aggravated osteoporosis, deep venous thrombosis of the lower limbs, lung infection, urinary tract infection, calculi and decubitus, and other complications, which seriously affect the quality of life of the patient and cause a high disability rate9. Nevertheless, Sextant minimally invasive pedicle screw fixation is a complicated operation with a long operation time, and the operation itself can further aggravate secondary injury of the diseased vertebra10. Obviously, the characteristics of lost vertebral bone density in senile OSF patients are more likely to lead to screw loosening and even removal, resulting in the failure of the internal fixation surgery11.
As commonly used clinical treatments for a senile osteoporotic spinal fracture, PVP and PKP can restore vertebral function and improve the mobility of patients with higher surgical safety and better postoperative pain relief. However, the merits and demerits of both in treating osteoporotic spinal compression fractures are still debated. High-pressure perfusion in PVP surgery can cause leakage of the bone cement into the vertebrae, thus damaging the spinal cord and nerve roots and reducing the surgical effect to a certain extent12. Compared with PVP, PKP can observably reduce and avoid the risk of bone cement leakage, but the operation is longer13. Inevitably, the use of a balloon to dilate the diseased vertebra during PKP surgery also carries a potential risk of secondary vertebral injury14. Therefore, in this study, on the basis of PVP, elderly patients with OSF were treated by optimizing the puncture site during surgery, thus avoiding the risk of the spinal cord and nerve injury caused by the puncture itself. In this protocol, the case of a 68-year-old female patient with OSF who underwent a modified minimally invasive injection of bone cement (MIIBC) for the treatment of a seventh thoracic vertebra fracture is presented in detail.
Traditional open internal fixation is used with patients who have the neurological symptoms of a vertebral compression fracture and a fractured mass entering the spinal canal and pressing on the spinal cord and nerve roots15. This technique is especially suitable for individuals with severe violent vertebral trauma, such as from a car accident or falling from height. This kind of emergency surgery usually requires spinal canal decompression, which has a long operation time and a large area of trau…
The authors have nothing to disclose.
This work was supported by the Key Medical Research Project of Shanxi Province (2020XM51).
Bone cement | Heraeus Medical GmbH | 61805335 | |
Chest pad | Hengshui Hejia Medical Device Co., Ltd. | 1.00297E+13 | |
Computed tomography instrument | General Electric Company | Discovery CT750 HD | |
Dualenergy X-ray absorptiometry | General Electric Company | Discovery XR656 | |
Kirschner wire | Tianjin Yutong Medical Device Factory | 210401 | |
Lidocaine | Shiyao Silver Lake Pharmaceutical Co., Ltd. | C22B042 | |
Nuclear magnetic resonance apparatus | General Electric Company | Achieva 1.5T | |
Povidone iodine solution | Wen Shui Greatly Industrial Co., Ltd. | 20220801 | |
Puncture needle | Dragon Crown Medical Co., Ltd. | 22040601 | |
Soft pad | Yueyang Zhengyang Medical Device Co., Ltd. | HRT445 | |
Sterile covering | Suqian Hongzhilong E-commerce Co., Ltd. | 56200331882 | |
Sterile surgical gauze | Hainuo Group Co. Ltd. | 7918087 | |
Surgical hammer | Hengshui Wankai Trading Co., Ltd. | 5.20808E+11 | |
Syringe | Shandong Weigao Group Medical Polymer Co., Ltd. | 20220101 | |
Vertebroplasty bone cement filler set | Shenzhen Hanqiang Medical Device Co., Ltd. | TF210301 | |
X-ray instrument | Shenzhen Rayvision Technology Co., Ltd. | ALC-200H |
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