title: Short-segment pedicle instrumentation with transpedicular bone grafting for nonunion of osteoporotic vertebral fractures involving the posterior edge.
abstract: Most osteoporotic vertebral fractures (OVFs) can be treated successfully with conservative methods. In about 10% of patients, nonunion develops and warrants surgical management with minimally invasive procedures such as vertebroplasty and kyphoplasty. Nevertheless, for patients with nonunion fractures that involve the posterior vertebral body wall, vertebroplasty and kyphoplasty are relatively contraindicated due to the risk of extravertebral polymethylmethacrylate cement leakage through vertebral fracture cracks. To this end, we developed a method for pedicle screw fixation combined with transpedicular bone grafting for such a condition. Briefly, after posterior pedicle screw fixation and reduction in the affected vertebra, the demineralized bone matrix was inserted into the vertebral body via a 'bone grafting funnel' created through the pedicle of the affected vertebra. The current retrospective study analysed the safety and efficacy of this approach. A total of 12 patients who fulfilled the criteria were treated with this procedure. Visual analogue scale scores for back pain and anterior vertebral heights were recorded. At 3-month follow-up, pain was significantly relieved compared with presurgery and the anterior vertebral heights were successfully restored and maintained. In conclusion, short-segment pedicle instrumentation combined with transpedicular bone grafting is a useful alternative in the treatment of nonunion of OVFs with loss of posterior edge integrity.
authors: Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou 215006, Jiangsu, China. orthopaedics123@hotmail.com
authors: Dapeng
authors: D
authors: Li
authors: Yonghui
authors: Y
authors: Huang
authors: Huilin
authors: H
authors: Yang
authors: Taicun
authors: T
authors: Sun
authors: Yan
authors: Y
authors: Wu
authors: Xuefeng
authors: X
authors: Li
authors: Liang
authors: L
authors: Chen
mesh_terms: D000368:Aged; D001416:Back Pain / Q000601:surgery; D001863:Bone Screws; D016025:Bone Transplantation / Q000379:methods*; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods*; D005599:Fractures, Ununited / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000601:surgery*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000601:surgery*; D016896:Treatment Outcome