New Technologies in Treatment of Pathologic Fractures

D.N. Dzukaev, V.I. Semchenko, O.N. Dreval

(Municipal Clinical Hospital N 67;
The Faculty of Neurosurgery of the Russian Medical Academy of Postgraduate Education, Moscow)

Injuries of the vertebral column, watched against a background of osteoporosis, are most frequent at the age above 45. They lead to considerable limitation of activity and disability. Up to now osteoporosis has always been a contraindication for using metal constructions with the purpose of spine stabilization and, thus, a cause of a negative effect on treatment quality and disability duration.

The goal of the present study has been to estimate efficiency of different modalities for treatment of pathologic fractures; to develop a method, based on use of an original transpedicular system; to elaborate an optimum algorithm for examination of cases with pathologic fractures.

Material and Methods. We performed 20 operations, using a transpedicular system with hollow screws. The majority of cases, treated in the Department of Spinal Neurosurgery of Municipal Clinical Hospital N 67 in 2002-2006, had fractures of the thoracolumbar spine against a background of osteoporosis. All the fractures were unstable. The overwhelming majority of cases was represented by females, aged 45-75. Radicular syndrome was the main neurological disorder, watched in almost all the cases. Preparation for operation consisted in standard, MRI and CT examination, as well as X-ray densitometry. All the cases underwent transpedicular fixation with use of original hollow screws, which allowed to administer bone cement into a vertebral body. Control CT-examination was carried out postoperatively.

Results. A greater part of the operated cases got out of bed on the third-forth day after intervention. Control CT examination demonstrated efficient fixation and filling of more than a half of a vertebral body volume by bone cement. Some cases had insignificant penetration of cement beyond the limits of a vertebral body and its accumulation below the anterior longitudinal ligament. However, it did not affect their state. There was regression of pain and radicular syndromes in all the cases. It happened a week after operation and allowed to carry out active rehabilitation. In our opinion, this fixation method can be used quite successfully in cases with pathologic fractures of the spine.