Two-year outcomes of minimally invasive hybrid stabilization with double-threaded polyaxial screws for unstable osteoporotic vertebral fractures

Introduction:
This study investigates the effect of fracture location on outcomes following minimally invasive hybrid stabilization (MIHS) with uncemented, double-threaded polyaxial screws in patients with unstable osteoporotic vertebral fractures.

Methods:
A prospective cohort of 73 patients (71.23% female; mean age: 79.9 ± 8.8 years) with OF 3–4 fractures received MIHS between November 2015 and January 2018. Fractures were classified into thoracolumbar (71.23%), thoracic (10.97%), and lumbar (17.8%) locations. Patient demographics, surgical parameters, and clinical and radiological outcomes—functionality, pain, and quality of life—were assessed over a 24-month follow-up.

Results:
Most surgeries (73.97%) were completed in under 120 minutes, and 97.25% had blood loss below 500 ml. No in-hospital mortality was reported. Spine-related complications occurred in 15.07% and non-spine complications in 35.62%, including urinary tract infections in 36.98%. Average hospital stay was 13.38 ± 7.20 days. Clinically significant screw loosening was observed in 1.7% of cases, with secondary adjacent fractures in 5.48%. Radiological improvements included a 5.4° increase in alpha-angle and beta-angle reduction from 16.3° ± 7.5 to 10.8° ± 5.6, with a slight increase at 24 months. Functional outcomes (COMI score) at 24 months varied by fracture location, though pain and quality of life were unaffected.

Conclusions:
MIHS with uncemented polyaxial screws is effective for stabilizing single-level osteoporotic fractures. While fracture location did not influence radiological reduction, it significantly impacted functional outcomes at 24 months, highlighting the need to consider fracture level in managing osteoporotic spine fractures.

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