Full Percutaneous Lumbar Stabilization In Osteoporotic Patients With Intraprocedural Cement Viscosupplementation

Congress:

ECR 2020

Poster Number:

C-04132

Type:

Scientific Exhibit

Keywords:

Performed at one institution, Experimental, Retrospective, Outcomes, Osteoporosis, Vertebroplasty, Technical aspects, Experimental investigations, Fluoroscopy, Musculoskeletal spine, Interventional non-vascular, Interventional Radiology

Authors:

R. Fiori¹, L. Spiritigliozzi², M. Forcina², C. Di Donna², A. U. Cavallo¹, A. d'onofrio¹, R. Floris²; ¹Rome/IT, ²Roma/IT

DOI:

10.26044/ecr2020/C-04132

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-04132

Fig. 1: LL view of cannulated screws inserted into the vertebral bodies

Fig. 2: Viscosupplementation through cannulated screws

Fig. 3: Post procedural AP X-ray projection

Fig. 4: Post procedural LL X-ray projection

Purpose

Vertebral interbody fusion is the primary treatment for degenerative disc disease resistant to medical therapy. Osteoporosis represents a contraindication to surgical and mini-invasive approaches because of the fragility of vertebral bones that could not support screws fixing and cage placement. We introduced a novel full percutaneous stabilization technique with bars and screws achieving safe vertebral fusion in osteoporotic patients thanks to a viscosupplementation with vertebroplasty during the same procedure through cannulated screws.

Methods and materials

Between February 2017 and January 2018, we performed this innovative percutaneous procedure in 28osteoporotic patients (T-score up to -3SD) with degenerative disk disease with associated low back pain resistant to medical therapy and/or spondylolisthesis up to grade 2 according to the Meyerding classification in the absence of vertebral fractures. Other exclusion criteria wereneoplasm,drug abuse, bone infection, or systemic diseases.Using cannulated screws, we performed the vertebroplasty during the same procedure of stabilization in order to restore adequate bone stiffness and resistance, ensuring more solid fixing of...

Results

We obtained a significant reduction in pain symptoms, and no poor results nor significant complications were reported. Besides, we did not report any displacement or ''pull out'' of the screws. Mean operation time was 110 minutes, and mean postoperative time until hospital discharge was two days. Postoperative values for VAS scores and ODI improved significantly compared to pre-operative data in all cases. The mean preoperative value of VAS score was 7,43 and decreased respectively to 2,87 at a 1-month follow-up, 2,32at 6 months and to...

Conclusion

Our preliminary results show that this full percutaneous lumbar stabilization technique may represents an innovative and suitable approach even for osteoporotic patients that used to be no suitable for this kind of procedure.

Personal information and conflict of interest

L. Spiritigliozzi; Rome/IT - nothing to disclose R. Fiori; Rome/IT - nothing to disclose M. Forcina; Rome/IT - nothing to disclose C. Di Donna; Rome/IT - nothing to disclose R. Floris; Rome/IT - nothing to disclose A. D'onofrio; Rome/IT - nothing to disclose A. U. Cavallo; Rome/IT - nothing to disclose

References

1.Dhall SS, Wang MY, Mummaneni P V. Clinical and radiographic comparison of mini–open transforaminal lumbar interbody fusion with open transforaminal lumbar interbody fusion in 42 patients with long-term follow-up.J Neurosurg Spine. 2008. doi:10.3171/SPI.2008.9.08142 2.Broek JL, Akl EA, Alonso-Coello P, et al.Grading quality of evidence and strength of recommendations in clinical practice guidelines: Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions.Allergy Eur J Allergy Clin Immunol. 2009. doi:10.1111/j.1398-9995.2009.01973.x 3.Adogwa O, Parker SL, Bydon A, Cheng J, McGirt...