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Unstable Vertebral Body Fractures in Elderly Patients - How Stable is Percutaneous Internal Fixation?

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Author(s): Marc Chmielnicki, Reiner Stenz, Axel Prokop

Journal: Journal of Orthopaedics
ISSN 0972-978X

Volume: 7;
Issue: 4;
Date: 2010;
Original page

Keywords: osteoporotic fractures | thoracolumbar spine | Sextant | minimally-invasive

ABSTRACT
Introduction:With unstable thoraco-lumbar vertebral fractures primary stabilization with internal fixator is the operative method of first choice. With osteoporosis with older patients anchoring is unsafe and vertebrae may lose height secondarily. We want to analyze retrospectively the behavior of such unstable osteoporotic fractures. Material and Methods:In 2007 and 2008 61 patients older than 60 years with an average age of 73 ± 8 years (60-88 years) with unstable thoraco-lumbar vertebral fractures were treated with a percutaneous internal fixator. Preoperatively, postoperatively and after six weeks of functional treatment without a brace the kyphosis angle was determined in a lateral radiography and compared with Student-t-Test. In 7 cases cement-augmented screws were used. Results:Kyphosis angle preoperative was 13,9 ± 9,4° and postoperative 8,1 ± 6,7°. Thus a reduction of height of 5,8 ± 5,9° (p < 0,001) was achieved by the operation. Within the first six weeks postoperative, however, loss of height of 7,7 ± 7,4° (p < 0,001) occurred, caused by cutting out of screws through the vertebra, as the screw-rod connections remained constant in all cases without significant changes. With the operations with cement-augmented screws there was no loss of height.Unstable vertebral fractures with patients over 60 years cannot be held by the fixator alone. Loss of reduction occurred from the cutting-out of screws in osteoporotic bone. Therefore, either in one or in two operations, stabilization of ventral column must be performed, or in addition cement augmentation of pedicle screws.
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