[Augmented posterior instrumentation for the treatment of osteoporotic vertebral body fractures].

OBJECTIVE: Reduction and stabilization of osteoporotic vertebral body fractures using posterior short-segment instrumentation. Cement augmentation of the pedicle screws in order to improve the screw’s holding power in osteoporotic bone and to reduce postoperative loss of reduction. Quick and painless postoperative mobilization without further bracing. INDICATIONS: Burst fractures (type A3 according to Magerl). Posttraumatic kyphosis following osteoporotic vertebral body fractures. Revision surgery after screw loosening. Type B and C fractures according to Magerl. CONTRAINDICATIONS: Osteoporotic fractures which are suitable for nonoperative treatment or percutaneous cement augmentation techniques (vertebroplasty, kyphoplasty). Vertebral body fractures in patients with good bone quality. SURGICAL TECHNIQUE: Insertion of pedicle screws in a typical manner. If perforated screws are used, cement application under fluoroscopic control via the central perforation of the screws. If pedicle screws without perforation are used, application of the cement using a Kyphoplasty technique and insertion of the screws. After hardening of the cement, completion of the instrumentation. POSTOPERATIVE MANAGEMENT: Mobilization starting on the first day after surgery. Avoidance of heavy lifting and manual labor for 3 months. Implant removal only if it is necessary due to complications.
RESULTS: Between July 2008 and December 2009, 10 patients with osteoporotic vertebral body fractures of the thoracic and lumbar spine were treated with cement-augmented posterior instrumentation. The mean age was 65.8 years (range 35–94 years). There were six type A (2 A1 and 4 A3 lesions) and four type B lesions (1 B1, 1 B2, and 2 B3 lesions) according to Magerl. Indications for cement augmentation of the pedicle screws were the patients’ age (4 patients), osteoporosis with t scores < − 2.5 (2 patients), poor intraoperative screw hold (2 patients), and revision surgery after loosening of pedicle screws (2 patients). Cement leakage was observed in 5 patients with no further clinical relevance. Loosening of cement augmented pedicle screws occurred in 1 patient with a consecutive loss of reduction of 10°. There was no need to remove any of the cement-augmented screws in the first 24 months.