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  • Percutaneous VS open expandable pedicle screws fixation in the treatment of vertebral osteoporotic fracture. Comparative clinical and radiological study.

    Final Number:

    Roberto Gazzeri MD; Andrea Faiola MD; Claudio Fiore

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Management of adult spinal fractures in osteoporotic patients poses great challenges to the spine surgeon and has historically been associated with relatively high rates of complications and need for reoperation. The incidence of screw loosening increases significantly in elderly patients with severe osteoporosis.

    Methods: 24 Consecutive osteoporotic patients with posterior fixation using expandable pedicle screws after thoracolumbar spinal fractures were included in the study. Patients were divided in two groups: Group I, treated with percutaneous expandable screws (Osseoscrew/Illico - Alphatec Spine) ; Group II, patients treated with expandable pedicle screws in open approach (Osseoscrew - Alphatec Spine) . Preoperative DEXA BMD examination showed a mean T-Score of -2.9. Patients were observed for a minimum of 2 years. Outcome measures included Visual Analogue Scale, Oswestry Disability Index and radiological screw loosening.

    Results: With the exception of osteoporotic status, there were no significant differences in the baseline status between the two groups. In Group I 10 patients were treated, while 14 patients were included in Group II . Postoperative length of hospital stay was shorter in Group I patients (mean 4.3 days) than in Group II cases (mean 6.4 days). At 1 and 2 years follow up, the VAS and ODI was markedly improved in the two groups. At 12 and 24 months radiological follow up there were no instances of screw loosening or pull-out, and the screw-bone interface was good in both groups. Dynamic X-rays revealed non-motion of the screws in the osteoporotic vertebrae.

    Conclusions: Expandable pedicle screws can decrease the risk of screw loosening and achieve a better fixation strength and clinical results in osteoporotic spinal fusion. Percutaneous spinal fixation achieves a faster pain improvement and a shorter postoperative length of stay in hospital compared to open approach.

    Patient Care: choosing the most convenient and safe procedure to treat osteoporotic vertebral fracture

    Learning Objectives: By the conclusion of this session, partecipants should be able to choose the most convenient and safe procedure to treat osteoporotic vertebral fracture


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