[Introduction] Posterior fixation, in conjunction with percutaneous vertebral augmentation techniques, such as balloon kyphoplasty (BKP) and vertebral body stenting (VBS), represents a surgical option for addressing unstable osteoporotic vertebral fractures (OVFs). The necessity for both robust fixation strength and minimized invasiveness poses a dichotomous challenge, particularly when dealing with the geriatric demographic. In this study, we introduce a novel surgical technique using percutaneous vertebral augmentation, complemented by posterior short fixation using percutaneous upward/downward endplate penetrating screws (PES). The aim of this study is to retrospectively analyze the clinical outcomes associated with this method, based on a cohort of twenty consecutive cases subjected to this technique.
[Methods] Surgical indications for this particular procedure are delineated by the presence of more than two of the following four poor prognostic radiographic findings: 1) functional instability, quantified radiographically with angles exceeding 10 degrees, 2) pedicle fractures, 3) fractures of the vertebral posterior wall, and 4) diffuse signal change in the T1-weighted sagittal MRI images. Twenty consecutive cases from March 2022 to April 2024, including sixteen males and nine females, ranging from 68 to 94 years in age, with an average age of 82.9 years are included. A brief synopsis of the surgical procedure is as follows: subsequent to the percutaneous vertebral augmentation, bilateral percutaneous pedicle screws, penetrating the caudal endplate, are introduced into the cephalad vertebral body, using the downward PES technique, and screws penetrating the cranial endplate are inserted into the caudal vertebral body. Furthermore, short pedicle screws are inserted within the affected vertebrae. Bilateral rods contoured into an arc are percutaneously introduced and secured, one above and one below.
[Results] The mean duration until postoperative discharge amounted to 15.6 days, and the average follow-up interval was 251 days (ranging from 13 to 729 days). The affected vertebrae were distributed as follows: T12 - 7 cases, L1 - 11 cases, L2 - 3 cases, L3 - 2 cases, L4 - 2 cases. The average surgical time was 58 minutes (ranging from 45 to 89 minutes), with estimated blood loss averaging 11 mL (ranging from 0 to 67 mL). At the time of discharge, 24 out of 25 patients except one patient who developed hyponatremia regained the ability to walk with a walker or better. Bone union was achieved in all 15 cases that were followed up for more than 3 months postoperatively. Screw loosening was observed in 7 cases during the follow-up period; however, bone union was confirmed in the 7 cases at the final asessment.
[Discussion] We present favorable short-to-mid-term clinical results of the novel minimally invasive surgical procedure for 25 unstable OVF cases. Additional long-term follow-up is desired to prove the usefulness.