Efficacy of stage Ⅰ modified posterior vertebral column resection in the treatment of postoperative infection after percutaneous vertebroplasty for osteoporotic vertebral compression fracture
Objective To explore the efficacy of stage Ⅰ modified posterior vertebral column resection(mPVCR)in the treatment of postoperative infection after percutaneous vertebroplasty(PVP)for osteoporotic vertebral compression fracture(OVCF).Methods A retrospective case series study was conducted to analyze the clinical data of 11 OVCF patients with post-PVP infection who were admitted to Zhengzhou Orthopedics Hospital from January 2016 to June 2022,including 4 males and 7 females,aged 61-81 years[(70.2±6.4)years].Injured segments included T9 in 1 patient,T11 in 2,T12 in 3,L,in 1,L2 in 2,T11-T12 in 1,and T12-L,in 1.American Spinal Injury Association(ASIA)grading was grade D in 5 patients and grade E in 6.All the patients were treated with stage Ⅰ mPVCR.The operation time and intraoperative bleeding volume were recorded.The values of Visual Analogue Scale(VAS),Oswestry Dysfunction Index(ODI),and Cobb angle of the lesion segments before,at 2 weeks,3 months after surgery,and at the last follow-up were compared.The loss of Cobb angle of the lesion segments at 2 weeks after surgery and at the last follow-up were compared,and the ASIA grading at the last follow-up was recorded.The infection control,bone healing,and the incidence of complications were observed at the last follow-up.Results All the patients were followed up for 12-44 months[(26.0±9.4)months].The operation time and intraoperative bleeding volume were 230-330 minutes[(279.2±28.6)minutes]and 500-1 100 ml[(840.9±184.1)ml]respectively.At 2 weeks,3 months after surgery and at the last follow-up,the VAS scores were(4.0±0.8)points,(2.7±0.9)points,and(2.4±0.7)points respectively,which were all lower than that before surgery[(8.1± 1.2)points](P＜0.01);the ODI was(45.5±5.1)％,(30.0±6.5)％,and(18.5±3.6)％respectively,which were all lower than that before surgery[(78.7±6.2)％](P＜0.01);the Cobb angle of the lesion segments were(7.9±1.4)°,(8.5±1.4)°,and(9.2±1.5)° respectively,which were lower than that before surgery[(25.5± 9.2)°](P＜0.01).The VAS and ODI were both improved at 3 months after surgery compared with those at 2 weeks after surgery(P＜0.05),while there was no significant difference in Cobb angle of the lesion segments(P＞0.05).The ODI was further improved at the last follow-up compared with that at 3 months after surgery(P＜0.05),while there were no significant differences in VAS or Cobb angle of the lesion segments(P＞0.05).The loss of Cobb angle correction of the lesion segment at the last follow-up was 0.96(0.69,1.45)°compared with that at 2 weeks after surgery and the rate of loss of Cobb angle correction of the lesion segment was 4.4(2.2,7.4)％.At the last follow-up,the ASIA grading was grade E for all the patients,who were able to walk normally independently.The infection was all cured and good bony fusion was observed in the operated area at the last follow-up.Two patients had pleural effusion and pulmonary atelectasis,1 incision fat liquefaction,and 1 pneumonia after the surgery.None of the patients had internal fixation failure and serious complications such as worsening neurological symptoms or death.Conclusion StageⅠ mPVCR for the treatment of post-PVP infection in patients with OVCF is proved to attain significant pain relief and functional improvement,good correction results,effective reconstruction of spinal stability,complete removal of infected lesions,and few serious complications.
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