Lukas Weiser1, Stephan Sehmisch2, Wolfgang Lehmann2, Lennart Viezens2. 1. Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Deutschland. Lukas.Weiser@med.uni-goettingen.de. 2. Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37099, Göttingen, Deutschland.
Abstract
OBJECTIVE: Operative stabilisation of osteoporotic vertebral fractures. INDICATIONS: Fractures of the thoracic and lumbar spine. CONTRAINDICATIONS: None. SURGICAL TECHNIQUE: Preoperative determination of expected bone mineral density. Implantation of pedicle screws in special trajectories, cement augmentation of the screws and use of alternative implants. POSTOPERATIVE MANAGEMENT: Early functional mobilisation and initiation of osteoporosis therapy if indicated. RESULTS: A biomechanical cadaver study with human vertebral bodies was performed. There was a highly significant correlation between bone mineral density and the fatigue load (r2 = 0.839, p < 0.001). Specimens with bone mineral density below 80 mg/cm3 only reached 60% of the fatigue load compared to the specimens with adequate bone quality (>120 mg/cm3) and therefore stability mightbe insufficient and an additional stabilisation should be considered. In osteoporotic vertebrae, the fatigue strength of cement augmented screws was increased by 52% compared to the non-augmented screws (fatigue load non-augmented: 173 N, augmented: 263 N; p = 0.001). Studies conducted by other research groups have demonstrated the effect of various screw trajectories and alternative implants to improve stability in the treatment of osteoporotic vertebral body fractures.
OBJECTIVE: Operative stabilisation of osteoporotic vertebral fractures. INDICATIONS: Fractures of the thoracic and lumbar spine. CONTRAINDICATIONS: None. SURGICAL TECHNIQUE: Preoperative determination of expected bone mineral density. Implantation of pedicle screws in special trajectories, cement augmentation of the screws and use of alternative implants. POSTOPERATIVE MANAGEMENT: Early functional mobilisation and initiation of osteoporosis therapy if indicated. RESULTS: A biomechanical cadaver study with human vertebral bodies was performed. There was a highly significant correlation between bone mineral density and the fatigue load (r2 = 0.839, p < 0.001). Specimens with bone mineral density below 80 mg/cm3 only reached 60% of the fatigue load compared to the specimens with adequate bone quality (>120 mg/cm3) and therefore stability mightbe insufficient and an additional stabilisation should be considered. In osteoporotic vertebrae, the fatigue strength of cement augmented screws was increased by 52% compared to the non-augmented screws (fatigue load non-augmented: 173 N, augmented: 263 N; p = 0.001). Studies conducted by other research groups have demonstrated the effect of various screw trajectories and alternative implants to improve stability in the treatment of osteoporotic vertebral body fractures.
Entities:
Keywords:
Bone mineral density; Osteoporosis; Osteoporotic fracture; Pedicle screw; Spine
Authors: J-S Jarvers; S Schleifenbaum; C Pfeifle; C Oefner; M Edel; N von der Höh; C-E Heyde Journal: BMC Musculoskelet Disord Date: 2021-05-05 Impact factor: 2.362
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