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Short-segment pedicle instrumentation with transpedicular bone grafting for nonunion of osteoporotic vertebral fractures involving the posterior edge

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Abstract

Most osteoporotic vertebral fractures (OVFs) can be treated successfully with conservative methods. In about 10% of patients, nonunion develops and warrants surgical management with minimally invasive procedures such as vertebroplasty and kyphoplasty. Nevertheless, for patients with nonunion fractures that involve the posterior vertebral body wall, vertebroplasty and kyphoplasty are relatively contraindicated due to the risk of extravertebral polymethylmethacrylate cement leakage through vertebral fracture cracks. To this end, we developed a method for pedicle screw fixation combined with transpedicular bone grafting for such a condition. Briefly, after posterior pedicle screw fixation and reduction in the affected vertebra, the demineralized bone matrix was inserted into the vertebral body via a ‘bone grafting funnel’ created through the pedicle of the affected vertebra. The current retrospective study analysed the safety and efficacy of this approach. A total of 12 patients who fulfilled the criteria were treated with this procedure. Visual analogue scale scores for back pain and anterior vertebral heights were recorded. At 3-month follow-up, pain was significantly relieved compared with presurgery and the anterior vertebral heights were successfully restored and maintained. In conclusion, short-segment pedicle instrumentation combined with transpedicular bone grafting is a useful alternative in the treatment of nonunion of OVFs with loss of posterior edge integrity.

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Acknowledgments

The authors thank Liangju Sheng (Radiologist, Radiology Department, Affiliated Hospital of Jiangsu University) and Xingbing Cao (Statistician, Department of Statistics, Jiangsu University) for their help during data collection. We also thank Krishnaumar Alagirisamy (Doctor of Spine Surgery, Institute of Clinical Medicine, Jiangsu University) who helped us in editing of this paper.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, Jiangsu, China

    Dapeng Li, Yonghui Huang, Huilin Yang & Xuefeng Li

  2. Department of Orthopaedic Surgery, Affiliated Hospital of Jiangsu University, No.438 Jiefang Street, Zhenjiang, 212001, Jiangsu, China

    Dapeng Li, Yonghui Huang, Taicun Sun, Yan Wu & Liang Chen

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  1. Dapeng Li
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  2. Yonghui Huang
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  3. Huilin Yang
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  5. Yan Wu
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  6. Xuefeng Li
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  7. Liang Chen
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Correspondence to Dapeng Li.

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Li, D., Huang, Y., Yang, H. et al. Short-segment pedicle instrumentation with transpedicular bone grafting for nonunion of osteoporotic vertebral fractures involving the posterior edge. Eur J Orthop Surg Traumatol 23, 21–26 (2013). https://doi.org/10.1007/s00590-011-0928-1

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  • DOI: https://doi.org/10.1007/s00590-011-0928-1

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