New short-segment multi-rod posterior instrumented fixa-tion of lumbar burst osteoporotic fractures: a comparative analysis of clinical outcomes

There is a need to improve technologies of posterior spinal fixation for osteoporotic fractures. To comparatively analyze the results of using the new method of short-segment multi-rod posterior instrumented fixation developed by the authors in patients with neurologically intact lumbar burst osteoporotic fractures (OF3 and OF4 according to the AO Spine-DGOU classification) relative to classical open long-segment pedicle screw instrumentation with bone cement vertebroplasty. The treatment outcomes of 47 patients were studied: first group (22 patients) – new short-segment multi-rod posterior fixation without cement augmentation of pedicle screws; second group (25 patients) – open pedicle eight-screw fixation without cement augmentation of screws, with vertebroplasty of the fractured vertebra using polymethyl methacrylate bone cement. Methods of nonparametric statistics were used. The advantages of the new fixation method stemmed from the lower extent and invasiveness of surgery, which was reflected in reduced blood loss (p = 0.0001), shorter surgical time (p = 0.0002), and shorter postoperative inpatient treatment (p = 0.0348), as well as in faster recovery of quality of life (p < 0.05) for at least six months after surgery. At 24 months after surgery, clinical and radiologic outcomes were similar (p > 0.05). The new fixation method can be considered a serious alternative to long-segment pedicle screw instrumentation in the presence of any barriers limiting the possibility of high-quality implementation of its minimally invasive percutaneous option, as well as of manipulations aimed at reconstruction of the fractured vertebral body under conditions of reduced bone mineral density.

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