• 1

    Opciones de tratamiento quirúrgico mínimamente invasivo en las fracturas vertebrales osteoporóticas OF4

    Revista Española de Cirugía Ortopédica y Traumatología 2022;66(2): 86-94

    medes_medicina en español

    BURGUET GIRONA S, FERRANDO MESEGUER E, MARUENDA PAULINO JI

    Revista Española de Cirugía Ortopédica y Traumatología 2022;66(2): 86-94

    Tipo artículo: Artículo

    Resumen del Autor: Introduction and objective The incidence of osteoporotic vertebral fractures (OVF) is increasing. The importance of their diagnosis and treatment lies in their frequency and the morbidity they cause in patients. The classification proposed for OVFs by the German Society of Orthopaedics and Traumatology (DGOU) recommends surgical treatment for vertebral fractures classified as OF4. Most of these fractures will require anterior bracing as an adjunct to posterior fixation because of the significant loss of vertebral body structure. In elderly patients, minimally invasive surgery (MIS) allows their treatment given the lesser tissue aggression and systemic repercussions. We present the results of the treatment of OF4 vertebral fractures using minimally invasive techniques in the Spine Unit of our hospital. Material and methods Retrospective study of 21 patients with OF4 osteoporotic fractures in the thoracolumbar transition treated in our centre. Six patients who underwent open posterolateral fusion or isolated vertebroplasty were excluded. The series consists of 15 cases (13 females and 2 males), with a mean age of 72.2, studied by computed tomography and magnetic resonance imaging. Clinical and analytical data were collected to decide the most appropriate surgical technique. In six cases a retropleural/retroperitoneal MIS approach was performed for partial corpectomy with expandable vertebral substitute plus long posterior percutaneous fixation (technique 1). In the remaining nine cases long posterior percutaneous fixation + vertebroplasty of the fractured vertebra (technique 2). Radiological measurements were taken pre-surgically, post-surgically, at 6 weeks and 3 months, determining the fracture angle, kyphotic deformity, compression and wedging percentage and deformation angle. To assess functional outcome, patients completed the Oswentry Disability Index before surgery and at 3 months. Results There were no intraoperative complications of note. In the corpectomy group the mean hospital stay was 9.4 days, with a mean operative time of 250 min, a postoperative haemoglobin loss of 3.3 g/dL and two patients were transfused. In the percutaneous fixation and vertebroplasty group the mean was 5.55 days, surgery time 71 min and loss of 1.6 g/dL haemoglobin. There was one post-surgical haematoma requiring transfusion. None of the patients had to be reoperated during follow-up. Radiological measurements showed adequate correction with both techniques which was maintained over time with minimal loss. In functional outcomes assessed with the Oswentry, patients following technique 1 suffered greater worsening (15%) than those treated with technique 2 (10%). Conclusions In OWF classified as OF4, percutaneous fixation associated with vertebroplasty could be an alternative to corpectomy in older patients with comorbidities, in whom functional recovery is more important than radiological correction. The use of MIS surgery together with improvements in the prevention and treatment of osteoporosis may improve clinical outcomes in the treatment of this type of fracture.

    Notas:

     

    Palabras clave: Estudios descriptivos, Estudios observacionales, Estudios retrospectivos, Fracturas vertebrales, Ortopedia, Osteoporosis, Procedimientos quirúrgicos mínimamente invasivos , Tratamiento, Traumatología

    ID MEDES: 170268



    * RECUERDE. Al pulsar el enlace “Texto completo”, usted abandonará el entorno MEDES. En ese caso, la web a la que desea acceder no es propiedad de Fundación Lilly y, por tanto, ésta no se responsabiliza de los contenidos, informaciones o servicios presentes en ella, ni de la política de privacidad que aplique el sitio web de un tercero.