Vertebra-Pediculoplasty: A New Approach to Treatment of Split-Type and Delayed-Union Osteoporotic Vertebral Fracture with a Risk of Cement Dislodgement.

Abstract

The clinical outcomes of balloon kyphoplasty (BKP) for split-type osteoporotic vertebral fractures (OVF) are poor. These may be owing to the vertebral body bifurcating anteriorly and posteriorly when a load is applied and the filled cement being unstable. We report the usefulness of BKP combined with pediculoplasty using cannulated screws (vertebra-pediculoplasty) for OVF with a risk of cement dislodgement. Between April 2020 and February 2021, this surgery was performed on 10 patients with split-type and delayed-union OVF. The diagnosis was made using imaging findings on preoperative computed tomography or intraoperative images during balloon inflation. Early postoperative ambulatory rehabilitation was performed, and clinical outcomes were evaluated. Early pain relief was obtained in all patients. The stability of the fractured vertebrae was demonstrated using both supine and seated radiographs from the early postoperative period, and good clinical results were obtained. The cement in this surgery was stabilized using a cannulated screw in the vertebral body, anteroposteriorly, and craniocaudally. The cement mass integrated with the cannulated screw was stabilized with the vertebral lamina and pedicle as a stopper. Vertebra-pediculoplasty could be an effective method for managing OVF with a high risk of cement dislodgement, which has been difficult to treat using conventional BKP.