Association between bicortical screw fixation at upper instrumented vertebra and risk for upper instrumented vertebra fracture.
J Neurosurg Spine
; 26(5): 638-644, 2017 May.
Article
em En
| MEDLINE
| ID: mdl-28291409
ABSTRACT
OBJECTIVE The aim of this study was to investigate the risk of upper instrumented vertebra (UIV) fractures associated with UIV screw fixation (unicortical vs bicortical) and polymethylmethacrylate (PMMA) augmentation after adult spinal deformity surgery. METHODS A single-center, single-surgeon consecutive series of adult patients who underwent lumbar fusion for ≥ 4 levels (that is, the lower instrumented vertebra at the sacrum or pelvis and the UIV of the thoracolumbar spine [T9-L2]) were retrospectively reviewed. Age, sex, follow-up duration, sagittal UIV angle immediately postoperatively including several balance-related parameters (lumbar lordosis [LL], pelvic incidence, and sagittal vertical axis), bone mineral density, UIV screw fixation type, UIV PMMA augmentation, and UIV fracture were evaluated. Patients were divided into 3 groups Group U, 15 patients with unicortical screw fixation at the UIV; Group P, 16 with bicortical screw fixation and PMMA augmentation at the UIV; and Group B, 21 with bicortical screw fixation without PMMA augmentation at the UIV. RESULTS The mean number of levels fused was 6.5 ± 2.5, 7.5 ± 2.5, and 6.5 ± 2.5; the median age was 50 ± 29, 72 ± 6, and 59 ± 24 years; and the mean follow-up was 31.5 ± 23.5, 13 ± 6, and 24 ± 17.5 months in Groups U, P, and B, respectively (p > 0.05). There were no significant differences in balance-related parameters (LL, sagittal vertical axis, pelvic incidence-LL, and so on) among the groups. UIV fracture rates in Groups U (0%), P (31.3%), and B (42.9%) increased in sequence by group (p = 0.006). UIV bicortical screw fixation increased the risk for UIV fracture (OR 5.39; p = 0.02). CONCLUSIONS Bicortical screw fixation at the UIV is a major risk factor for early UIV compression fracture, regardless of whether a thoracolumbosacral orthosis is used. To reduce the proximal junctional failure, unicortical screw fixation at the UIV is essential in adult spinal deformity correction surgery.
Palavras-chave
APJF = acute proximal junctional failure; BMD = bone mineral density; LIV = lower instrumented vertebra; LL = lumbar lordosis; ODI = Oswestry Disability Index; PI = pelvic incidence; PJF = proximal junctional failure; PJK = proximal junctional kyphosis; PMMA = polymethylmethacrylate; SVA = sagittal vertical axis; UIV = upper instrumented vertebra; UIV compression fracture; UIV screw fixation; acute proximal junctional failure; bicortical screw fixation; surgical technique; upper instrumented vertebra
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Fusão Vertebral
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Parafusos Ósseos
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Fraturas da Coluna Vertebral
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Vértebras Lombares
Idioma:
En
Ano de publicação:
2017
Tipo de documento:
Article