title: Short-segment posterior instrumentation combined with calcium sulfate cement vertebroplasty for thoracolumbar compression fractures: radiographic outcomes including nonunion and other complications.
abstract: OBJECTIVE
  To evaluate the radiographic outcomes of short-segment posterior instrumentation plus vertebroplasty using injectable calcium sulfate cement (CSC) for thoracolumbar compression fractures.
  
  
  METHODS
  Twenty-eight patients with a single-level thoracolumbar compression fracture, who underwent short-segment pedicle screw fixation and CSC vertebroplasty, were included in the study. The anterior vertebral body height ratio, local kyphosis angle, and the height of the intervertebral disc adjacent to the fractured vertebra were used to evaluate the radiographic results. Complications including bone nonunion, instrument failure, cement leakage, and disc vacuum formation were also assessed.
  
  
  RESULTS
  The patients were followed up for an average of 24.20±5.40 months. The relative preoperative anterior body height was 55.71±15.29%, which improved to 94.93±5.39% immediately after surgery (P<0.001), and at final follow-up showed a 6.50±3.89% loss of height correction (P<0.001). The mean preoperative local kyphosis angle was 22.23±5.65°, which corrected to 2.67±4.43° immediately after surgery (P<0.001), but reverted to 6.71±4.95° at final follow-up, showing a 4.04±1.91° loss of correction (P<0.001). The mean height of the intervertebral disc proximal to the fractured vertebra was 9.87±0.91 mm before surgery, 12.53±0.98 mm after operation (P<0.001), and the loss of correction at final follow-up was 2.35±1.15 mm with a significant difference compared to immediate postoperative values (P<0.001). Bone nonunion occurred in 7 patients, 2 patients had hardware failure, 9 patients had cement leakage, and 10 patients had disc vacuum phenomenon adjacent to the fractured vertebra.
  
  
  CONCLUSIONS
  The patients who underwent this procedure had a loss of correction of vertebral height and local kyphosis. Complications such as bone nonunion, instrument failure, cement leakage, and disc vacuum may occur. Rapid CSC resorption accounts for these radiographic outcomes and complications.
  
  
  METHODS
  Level IV, retrospective study.
authors.affiliation: Department of Orthopedic, The First Affiliated Hospital, Zhengzhou University, No. 58 Jianshe Road, 450052 Zhengzhou, China; Luoyang Orthopedics and Traumatology Institution, Luoyang Orthopedic-Traumatological Hospital, No. 82 Qiming South Road, 471002 Luoyang, China.
authors.forename: B X
authors.initials: BX
authors.lastname: Bu
authors.affiliation: Luoyang Orthopedics and Traumatology Institution, Luoyang Orthopedic-Traumatological Hospital, No. 82 Qiming South Road, 471002 Luoyang, China.
authors.forename: M J
authors.initials: MJ
authors.lastname: Wang
authors.affiliation: Department of Orthopedic, Changzhou Wujin Hospital, Jiangsu University, No. 2 Yongning North Road, 213002 Changzhou, China.
authors.forename: W F
authors.initials: WF
authors.lastname: Liu
authors.affiliation: Department of Orthopedic, The First Affiliated Hospital, Zhengzhou University, No. 58 Jianshe Road, 450052 Zhengzhou, China.
authors.forename: Y S
authors.initials: YS
authors.lastname: Wang
authors.affiliation: Luoyang Orthopedics and Traumatology Institution, Luoyang Orthopedic-Traumatological Hospital, No. 82 Qiming South Road, 471002 Luoyang, China; Department of Orthopedic, Changzhou Wujin Hospital, Jiangsu University, No. 2 Yongning North Road, 213002 Changzhou, China. Electronic address: 13776817887@163.com.
authors.forename: H L
authors.initials: HL
authors.lastname: Tan
mesh_terms: D001843:Bone Cements / Q000494:pharmacology*; D002133:Calcium Sulfate / Q000494:pharmacology*; D003764:Dental Materials / Q000494:pharmacology; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements; D003764:Dental Materials; D002133:Calcium Sulfate
keywords: CSC vertebroplasty; Complications; Radiographic outcomes; Surgical treatment; Thoracolumbar fracture