Cortical screw trajectory for instrumentation and fusion in the setting of osteopathic compression fracture allows for percutaneous kyphoplasty for adjacent level compression fractures.
Spinal fixation in the osteoporotic patient can be challenging due to the poor trabecular bone quality of the vertebral body. Patients with osteoporotic vertebral body compression fractures are at risk for future compression fractures at adjacent levels, especially after cement augmentation. The purpose of this technical report is to describe the utilization of a cortical screw trajectory along with kyphoplasty for a patient with an osteoporotic compression fracture as well as degenerative spinal disease. This trajectory allows for the possibility of percutaneous pedicle access in the event of future compression fractures. Our patient underwent a decompressive laminectomy and kyphoplasty at the level of an osteoporotic compression fracture. The fracture was stabilized with cortical screw instrumentation and fusion at a level above and a level below the fracture. Subsequently the patient developed an adjacent level fracture within the fusion construct. Due to the utilization of a cortical screw trajectory for the initial fusion, the traditional pedicle trajectory was still accessible. As a result, the new fracture was treated with a percutaneous kyphoplasty through a standard pedicle trajectory. In conclusion, the use of a cortical screw trajectory for stabilization of osteoporotic compression fractures provides for a stronger bone screw interface and avoids osteoporotic trabecular vertebral body bone. At the same time this trajectory allows for future percutaneous pedicular access in the event that the patient suffers future compression fractures.
New York University, Department of Neurosurgery, 530 First Avenue, Skirball, Suite 8R, New York, NY 10016, USA.
Donato
D
Pacione
New York University, Department of Neurosurgery, 530 First Avenue, Skirball, Suite 8R, New York, NY 10016, USA.
Irene
I
Kim
New York University, Department of Neurosurgery, 530 First Avenue, Skirball, Suite 8R, New York, NY 10016, USA. Electronic address: Taylor.Wilson5@gmail.com.
Taylor A
TA
Wilson
New York University, Department of Neurosurgery, 530 First Avenue, Skirball, Suite 8R, New York, NY 10016, USA.
Anthony
A
Frempong-Boadu
D000369:Aged, 80 and over; D001863:Bone Screws; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty / Q000295:instrumentation* / Q000379:methods; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery; D016896:Treatment Outcome
Cortical screw trajectory; Degenerative spinal disease; Osteoporotic vertebral compression fracture; Spinal fixation