I.E. Valeev, E.K. Valeev
Scientific Research Centre of Tatarstan Rehabilitation Traumatology and Orthopedics, Kazan, Russia
Vertebroplasty is mainly used in compression fractures of vertebral bodies, conditioned by osteoporosis. Unstable injuries of the spine are usually treated with applying transpedicular devices. However, a failure of a stabilizing system, developing 3-4 months after operation is not a rare phenomenon. One of its causes is weakening of the anterior supporting column due to fracture.
The study goal has been estimating supporting ability of an injured vertebral body in combined use of vertebroplasty and transpedicular fixation.
There were 97 cases with injuries of the lower thoracic and lumbar spine, caused by a car crash and falling down from a considerable height. Their age varied from 21 up to 45 years (mean age - 31±8). Simultaneous vertebroplasty and transpedicular spondylodesis, combined with decompressive laminectomy when necessary, were performed during the 1st-10th days (54 cases). If there were bone fragments of a posterior segment of an injured vertebra, vertebroplasty was performed with protection of the spinal cord and its roots. A follow-up period was 1.5 years. As for cases with vertebroplasty, we did not reveal kyphotic deformity augmentation in the area of an injured segment of the vertebral column, as well as osteoporosis at the borderline of a screw and bone. Penetration of bone cement into small paravertebral vessels was observed in 3 cases; it had no clinical manifestations. Bone tissue resorption around a screw and its migration were watched in 11% and 13% of cases, respectively.
Thus, bone cement, administered into an injured vertebral body strengthens the anterior supporting column, improving fixing properties of a transpedicular system to a great extent. Vertebroplasty shortens stages of surgical intervention and does not demand additional and expensive devices for stabilization of a vertebral body.