Minimally Invasive Fixation in Osteoporotic Vertebral Fractures: A Review Article

Sie-Hiong Tan; Ming-Chi Kuo; Yu‑Cheng Yeh; Meng-Yin  Ho; Fon-Yih Tsuang

doi:10.18502/jost.v9i1.12563

Sie-Hiong Tan Division of Neurosurgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
Ming-Chi Kuo Division of Neurosurgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
Yu‑Cheng Yeh Spine Division, Department of Orthopedic Surgery, College of Medicine, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
Meng-Yin Ho Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan
Fon-Yih Tsuang Division of Neurosurgery, Department of Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan

DOI: https://doi.org/10.18502/jost.v9i1.12563

Keywords: Osteoporosis; Spinal Fracture; Review; Minimally Invasive Surgery; Bone Cement

Abstract

here are several surgical strategies which have been proposed to treat the osteoporotic patient with vertebral fracture, ranging from vertebral body cement augmentation, percutaneous/mini-open short segment pedicle screw fixation, and cortical bone trajectory screw to kyphotic deformity correction surgery. Minimally invasive spine surgery has the potential benefits of faster recovery, reduced blood loss, less postoperative wound pain, lower infection risk, and shorter length of hospital stay. Novel surgical techniques such as percutaneous instrumentation fixation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation are developed. However, various complications have been reported, including pedicle fracture, instrumentation loosening, adjacent-level disc degeneration with herniation, and progressive junctional kyphosis. The purpose of this review was to outline various advancements in minimally invasive spinal surgery for patients with osteoporosis. Minimally invasive surgical techniques for fixation including percutaneous instrumentation, cortical bone trajectory technique, screw cement augmentation, and vertebral body augmentation have benefited patient with osteoporosis. Studies and discussions about short-segment pedicle screw fixation (one level above and below the fracture level) have shown that it provides enough stability for thoracolumbar burst fractures. There are also complications, including cement embolism, adjacent vertebral fracture, neuraxial anesthesia, and infection, which have been observed with the above technique. With the advancement of instrument and technique, the complication rate decreased in recent studies. Minimally invasive fixation still has many advantages for patients with osteoporosis. Many of these studies and strategies only have evidence from biomechanical and cadaveric studies and require further clinical trials to establish their clinical efficacy.