The 'armed concrete' approach: stent-screw-assisted internal fixation (SAIF) reconstructs and internally fixates the most severe osteoporotic vertebral fractures.

Autor:	Distefano D; Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland daniela.distefano@eoc.ch., Scarone P; Department of Neurosurgery, Neurocenter of Southern Switzerland, Lugano, Switzerland., Isalberti M; Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland., La Barbera L; Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Québec, Canada.; Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy.; Sainte-Justine Clinical Hospital Center, Montréal, Quebec, Canada., Villa T; Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy., Bonaldi G; Department of Neurosurgery, Casa di Cura Igea, Milano, Lombardia, Italy., Hirsch JA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Cianfoni A; Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland.; Department of Interventional and Diagnostic Neuroradiology, Inselspital University Hospital Bern, Bern, Switzerland.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2021 Jan; Vol. 13 (1), pp. 63-68. Date of Electronic Publication: 2020 Sep 16.
DOI:	10.1136/neurintsurg-2020-016597
Abstrakt:	Background: The treatment of severe osteoporotic vertebral compression fractures (VCFs) with middle-column (MC) involvement, high fragmentation, large cleft and/or pedicular fracture is challenging. Minimally invasive 'stent-screw-assisted internal fixation' (SAIF) can reduce the fracture, reconstruct the vertebral body (VB) and fix it to the posterior elements. Objective: To assess feasibility, safety, technical and clinical outcome of the SAIF technique in patients with severe osteoporotic VCFs. Methods: 80 treated vertebrae were analyzed retrospectively. Severe VCFs were characterized by advanced collapse (Genant grade 3), a high degree of osseous fragmentation (McCormack grade 2 and 3), burst morphology with MC injury, pediculo-somatic junction fracture, and/or large osteonecrotic cleft. VB reconstruction was evaluated on postprocedure radiographs and CT scans by two independent raters. Clinical and radiological follow-ups were performed at 1 and 6 months. Results: SAIF was performed at 28 thoracic and 52 lumbar levels in 73 patients. One transient neurological complication occurred. VB reconstruction was satisfactory in 98.8% of levels (inter-rater reliability 96%, κ=1). Follow-up at 1 month was available for 78/80 levels and at 6 months or later (range 6-24, mean 7.9 months) for 73/80 levels. Significant improvement in the Visual Analog Scale score was noted at 1 and 6 months after treatment (p<0.05). Patients reported global clinical benefit during follow-up (Patient's Global Impression of Change Scale 5.6±0.9 at 1 month and 6.1±0.9 at 6 months). Fourteen new painful VCFs occurred at different levels in 11 patients during follow-up, treated with vertebral augmentation or SAIF. Target-level stability was maintained in all cases. Conclusions: SAIF is a minimally invasive, safe, and effective treatment for patients with severe osteoporotic VCFs with MC involvement. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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