RESUMEN
Vertebral fractures in diffuse idiopathic skeletal hyperostosis (DISH) are often unstable. We encountered a case of vertebral fracture at the caudal end of DISH in which vertebroplasty was performed via a double endplate penetrating screw (DEPS) trajectory, and short posterior fixation was performed using the DEPS technique on the cranial vertebrae, including the fractured vertebra; conventional pedicle screw to the caudal vertebrae; and cement-augmented fenestrated pedicle screws to the caudal end vertebra. A 93-year-old man presented with a vertebral fracture at the caudal end of a DISH after a fall. He underwent surgery for lower back pain due to spinal instability. Vertebroplasty via DEPS trajectory can shorten the posterior fixation range. Using cement-augmented fenestrated pedicle screws to the caudal end vertebra enables balancing of the posterior fixation force. This strategy should be considered when a vertebral fracture is found at the caudal end of the DISH.
RESUMEN
Background: A downward penetrating endplate screw (PES) technique combined with caudal anchor screws inserted in the upward direction under O-arm navigation (i.e., crossing screw technique) avoided screw backout and proximal junctional kyphosis (PJK) in three patients with osteoporotic vertebral body fractures and diffuse idiopathic skeletal hyperostosis (DISH). Methods: The PES techniques were utilized for patients with T12 (one patient) and L1 (two patients) spontaneous fusion across the targeted vertebrae, with minimal damage to the involved endplates/intervertebral discs. The average number of instrumented vertebrae was 5.3. Results: There were no perioperative complications over the mean follow-up period of 28.7 months; no screw loosening, and no PJK. Conclusion: The PES technique prevented screw backout, and PJK in three patients with lumbar osteoporotic vertebral fractures and DISH.
RESUMEN
INTRODUCTION: We have developed the single or double endplates penetrating screw (SEPS/DEPS) technique, which is a novel percutaneous pedicle screw (PPS) insertion technique suitable for osteoporotic vertebral body fracture (OVF) patients with diffuse idiopathic skeletal hyperostosis (DISH). This study aims to compare the effectiveness of this SEPS/DEPS technique with the conventional pedicle screw technique. METHODS: The screw is inserted upward from the outer caudal side of the pedicle toward the inner cranial side. Vertebrae affected with DISH were inserted with screws using the SEPS/DEPS technique, whereas non-fused vertebrae were inserted with screws using the conventional PPS technique. Twelve OVF patients with DISH were included in this study; three with SEPS/DEPS technique only and nine with a hybrid of both the DEPS and the conventional PPS techniques. As a control group, 12 OVF patients with DISH treated by conventional PPS. The rates of implant failures and of surgical complications were compared between the SEPS/DEPS group and the control group. The insertion torque was measured and compared between DEPS and conventional PPS in three hybrid patients. RESULTS: In the SEPS/DEPS group, 70 screws were inserted with the SEPS/DEPS technique and 56 screws were inserted with the conventional PPS technique. In the control group, 116 screws were inserted using the conventional PPS and the PS techniques. The loosening of screws was significantly less in screws inserted with the SEPS/DEPS technique (0/70 screws, 0%) than with screws inserted with the conventional technique (12/116 screws, 10.3%). The average insertion torque of DEPS was 2.25 Nm, which was 134% higher than that of conventional PPS which was 1.64 Nm (p = 0.04). CONCLUSIONS: This novel SEPS/DEPS technique has a higher insertion torque compared with the conventional PPS techniques and demonstrated itself to be an effective option for patients with concomitant bone fragility due to DISH.