Abstract:

BACKGROUND: For the elderly osteoporotic patients with osteoporotic thoracolumbar vertebral fractures, the inadequate ordinary power of pedicle screws in control or excessive load after the operation results in the loosening or prolapse of pedicle screws, leading to fixation failure or pseudoarthrosis.
OBJECTIVE: To observe effects of expansive pedicle screw (expansive pedicle screw, EPS) implantation for internal fixation of thoracolumbar osteoporotic fracture in the aged.
METHODS: A total of 16 patients with osteoporotic thoracolumbar vertebral compression fractures, 6 males and 10 females, aged 73.6 (59-83) years. There were single vertebral compression fractures in 11 cases, two vertebral fractures in 5 cases (non-leap fractures), of which there was burst fracture in 4 cases. There were T12 in 7 cases, L1 in 10 cases, L2 in 3 cases, and L4 in 1 case; preoperative spinal cord and nerve root compression in 4 cases. Expansive pedicle screw fixation placement was adopted, for a spinal cord compression spinal space-occupying more than 50%, laminectomy was performed. Fixed rods were installed, relying on a fixed bar to squeeze into the outer screw inside the hollow bolt, a pre-bend good stick was installed to restore vertebral height so that fractures reduced, burst fractures were subjected to transverse autologous iliac bone and articular process grafting.
RESULTS AND CONCLUSION: The wound of postoperative 16 patients healed without wound infection, cerebrospinal fluid leakage, or postoperative death. Postoperative X-ray and CT examination showed that the fracture had been reduced, and spinal cord compression disappeared. After 6 to 24 months follow-up, X-ray films showed fusion, without internal fixation loosening, fracture, false joint formation, or significant back pain. Postoperative vertebral anterior and posterior edge heights were significantly increased compared with preoperative heights (P≤0.01). Kyphosis range corrected was 11°-27°. Under the circumstances of no increase in screw length and diameter as well as decreased risk for vertebral pedicle fracture, expansive pedicle screw placement provides more reliable strength compared with the ordinary screw fixation and is an ideal fixation device for osteoporotic thoracolumbar vertebral fractures in aged patients.