First clinical results after cement-augmented Ringosteosynthesis for osteoporotic pincer fractures of the spine – A new percutaneous minimally invasive surgical procedure – As an alternative to long segment instrumentations
Tabea Miron (Berlin), Ina Moritz (Berlin), Yu-Mi Ryang (Berlin)
The treatment of osteoporotic vertebral body fractures is a major challenge due to their prevalence and impact on quality of life, especially in frail patients. The management of OF4-pincer fractures is particularly complex, as long-segment stabilisation with or without vertebral body replacement is usually recommended. Such invasive procedures are associated with significant perioperative risk. We present first clinical results of a new surgical procedure, minimally invasive percutaneous PMMA-augmented pedicle screw Ringosteosynthesis (ROS).
A cohort of 46 patients with osteoporotic OF4-pincer fractures between thoracal vertebrae 8 and lumbar vertebrae 5 was treated with ROS. Pre- and postoperative pain intensity (NRS) was assessed. In addition, intra- and postoperative complications, incidence of subsequent fractures, need for follow-up surgery and long-term pain intensity and quality of life during follow-up were investigated. Retrospective statistical data analysis.
31F and 15M with an average age of 77.7±6.5 years (52-91), BMI: 25.2±4.95 (18.4-40), ASA score: 2.5±0.65 (1-4) were operated on. After treatment with ROS, the NRS showed a significant reduction in pain by an average of 4.43±1.58 (1-9) points pre- to postoperatively (mNRS preop 7.88±1.51 (2-10); postop 3.44±1.55 (0-6); p<0.05). 69% of patients were followed up at 27.7±11.07(3-72) weeks on average, showing a long-term pain reduction of 5.6±1.58(0-7) points on the NRS compared to preop pain intensity. One intraoperative complication occurred with pedicle screw avulsion during rod placement. One patient had a subsequent fracture, 5 patients showed sintering in the fractured vertebral body on CT after 27.7±11.07(3-72) weeks.
This paper presents the clinical application of Ringosteosynthesis as a new minimally invasive surgical procedure as a promising alternative to long-segment stabilisation for thoracolumbar OF4 pincer fractures. Potential advantages of this minimally invasive technique include a reduced rate of union fractures, proximal junctional failure when instrumenting the fractured vertebral body alone, shorter operating time, less blood loss, faster recovery, shortened hospital stay and higher cost- efficiency. The significant reduction in pain intensity and the low rate of subsequent fractures and interventions indicate sufficient stability and effectiveness of Ringosteosynthesis in geriatric patients. Further long-term studies are required.