Balloon kyphoplasty can stabilize the vertebral body morphology by filling cement into the vertebral body for osteoporotic vertebral fractures. It is particularly effective for nonunion vertebral bodies. Improving alignment of whole spinal is difficult with fractured vertebroplasty alone. We hoped that combining vertebroplasty with fixation would improve spinal alignment and adjacent disorders. The purpose of this study that we evaluated to compare vertebroplasty alone and vertebroplasty with its combination with pedicle screws.
Method: The study included 44 patients, 12 men and 32 women, mean age of 78 years. Three groups were compared: vertebroplasty alone (A), vertebroplasty with upper and lower vertebra screw fixation (AS), Pedicle screws are inserted into the cemented vertebra and above and below it. (AS3). A group were 21 cases, AS were 13 cases, AS3 were 10 cases. The measurement items were the vertebral wedge angle of the fractured vertebrae and the angle between the two vertebral bodies above and below (local angle α).
Results: The vertebral body average angle was 10 degrees in group A (after treatment:14 degrees), 12 degrees in group AS (14 degrees), and 12 degrees in group AS3 (15 degrees), with no significant difference observed between the three groups. In group A, collapse of the underside endplate and adjacent vertebral fractures was observed after an average of 9 months. This sign was not observed in the AS and AS3 groups. The α angle was 39°/33° in group A, 35°/25° in group AS, and 38/22° in group AS3. The α angle was most improved in AS3.
Discussion: Vertebroplasty alone may be sufficient when treating only the vertebral body, if the damage to the vertebral endplate is mild and no disc degeneration is observed.
Conclusion:However, if the α angle exceeds 25 degrees, or if there is damage to the endplate or a disc vacuum, it is advisable to use screws in combination. It is particularly beneficial to use PS on 3 vertebral bodies. Vertebral fractures with an α angle of over 25 degrees, vertebral endplate damage, or disc vacuum should be treated with screws and it is particularly beneficial to use pedicle screw with 3 vertebral bodies, including fracture vertebra.