Factors affecting the stability of transpedicular fixation in patients with neglected osteoporotic vertebral fractures

Introduction With increasing life expectancy and an aging population, vertebral fractures are one of the most common fractures associated with low bone mineral density.the problem of vertebral fractures associated with low bone mineral density is becoming increasingly common. Despite a variety of treatment methods, the risk of transpedicular fixation instability in the postoperative period remains.

The objective was to identify risk factors for unstable spondylosynthesis in patients with osteoporotic spinal fractures to substantiate an individualized approach to the surgical treatment.

Material and methods This A retrospective single-center study was based on the findings of 82 patients who underwent surgical treatment at the R.R. Vreden National Medical Research Center for Trauma and Orthopedics between 2019 and 2023. Patients were divided into a case group of patients who developed unstable fixation, n = 8) and controls (who had no hardware instability, n = 74). Potential risk factors included age, body mass index, fixation length, a screw placed in the involved vertebra, screw diameter, the presence and type of bone cement augmentation, the amount of decompression, the presence of local kyphosis and correction technique (Schwab vertebrotomy), duration of surgery and blood loss.

Results A screw placed into the involved vertebra was the only statistically significant (p < 0.05) difference between the groups. A logistic regression model was used to identify factors that could improve the hardware stability including intermediate fixation, augmentation of the fractured vertebra, screw augmentation and a larger screw diameter. Laminectomy, facetectomy, advanced age, and excess body weight were identified as factors negatively affecting the stability of the metal construct.

Discussion Patients with osteoporotic vertebral fractures are heterogeneous in age and medical status which complicates selection of optimal surgical approaches. Laminectomy and facetectomy are the main factors impacting stability in case of facet joint resection. Larger-diameter screws and bone cement augmentation are practical for better stability and associated with a risk of specific complications. The screw placed in the broken vertebra is a significant positive factor, as confirmed by other biomechanical and clinical studies. Limitations of the study included the retrospective design, small sample size and cohort heterogeneity, which reduce the statistical power and generalizability of the results.

Conclusion Unstable transpedicular fixation after stabilization is multifactorial in patients with chronic osteoporotic vertebral fractures. Surgical factors are most significant. Laminectomy and facetectomy increase the risk of instability with the screw placed in the broken vertebra and bone cement augmentation helps maintain the stability. The length of fixation, the extent of kyphosis correction and residual kyphosis had no significant effect in the study sample. These results support the need for individualized surgical approaches in osteoporotic patients.

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