Vertebroplasty combined with image-guided percutaneous cement augmented transpedicular fixation for the treatment of complex vertebral fractures in osteoporotic patients

Aim. Surgical management of osteoporotic fractures constitutes a clinical challenge. The aim of this study was to evaluate feasibility and efficacy of navigated percutaneous screw fixation combined with multisegmental vertebroplasty for the treatment of osteoporotic fractures not suitable for monosegmental cement augmentation in patients with severe osteoporotic changes of the vertebral column and/or progressive kyphotic deformation. Methods. Navigated percutaneous screw fixation and simultaneous augmentation with vertebroplasty was performed in 6 patients with lumbar and 4 patients with thoracic osteoporotic fractures. In all cases, significant vertebral body collapse, destruction of the endplates and multisegmental osteoporotic changes were radiologically confirmed. Postoperative images were obtained in all cases to analyze the position of each screw and to assess further deformity progression. Follow-up ranged between 12 and 18 months. Results. There was no additional morbidity associated with screw or cement insertion. Cement leakage lateral to the vertebral body was observed in 4 cases. Mean total operation time (142 minutes) was prolonged due to intraoperative data acquisition for 15+/-6 minutes. In 2 cases a second data set had to be acquired due to poor image quality. Finally, mean intraoperative blood loss was 100ml. Clinical outcome was satisfactory in all cases. Radiological follow-up demonstrated loss of initial kyphosis correction in 8 cases. Conclusion. Navigated percutaneous screw fixation combined with multisegmental vertebroplasty is a technically feasible procedure. Despite the additional time needed for intraoperative data acquisition, total operation time was acceptable and intraoperative blood loss as well as muscle trauma were minimized compared to a standard open procedure. Despite good clinical outcome, the described construct failed to prevent further kyphotic deformation during the reported follow-up period.