Severe pathological fractures caused by vertebral hemangiomas with posterior decompression, bone cement augmentation and internal fixation

• Published in: Orthopaedics & traumatology, surgery & research Vol. 102; no. 4; pp. 489 - 494
• Main Authors: Li, C, Zhang, H.-B, Zhang, H, Li, Q, Zhang, J, Wang, J, Guo, K.-J, Wang, L.-X
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01-06-2016
• Subjects: Adult; Bone Cements - therapeutic use; Decompression, Surgical - adverse effects; Female; Follow-Up Studies; Fracture Fixation, Internal - adverse effects; Fractures, Spontaneous - diagnostic imaging; Fractures, Spontaneous - etiology; Fractures, Spontaneous - surgery; Hemangioma - complications; Hemangioma - surgery; Humans; Kyphosis - diagnostic imaging; Kyphosis - etiology; Kyphosis - surgery; Lumbar Vertebrae; Male; Middle Aged; Musculoskeletal Pain - etiology; Musculoskeletal Pain - surgery; Orthopedics; Pain Management; Pain Measurement; Pathological fractures; Pedicle screws fixation; Posterior surgical decompression; Postoperative Period; Spinal Fractures - diagnostic imaging; Spinal Fractures - etiology; Spinal Fractures - surgery; Spinal Neoplasms - complications; Spinal Neoplasms - surgery; Surgery; Thoracic Vertebrae; Vertebral hemangiomas; Vertebroplasty; Vertebroplasty - methods; Pedicle screws fixation; Vertebral hemangiomas; Posterior surgical decompression; Pathological fractures; Vertebroplasty
• ISSN: 1877-0568; 1877-0568
• DOI: 10.1016/j.otsr.2016.01.024

Abstract Aim To evaluate the treatment strategy for pathological fractures caused by vertebral hemangiomas (VHs) using large case series. Methods From January 2008 to January 2014, 28 patients suffering from severe pathological fractures (more than 2/3 loss of original vertebral height) due to thoracic or lumbar VHs were randomized to an experimental (the posterior decompression, bone cement augmentation and internal fixation, n = 14) or control (only the posterior decompression combined with internal fixation, n = 14) group. The anterior, middle vertebral body height, kyphosis angle and the cement leakage were measured on radiography. Visual analogue scale (VAS), 36-item short form (SF-36) and Oswestry disability index (ODI) were recorded to assess the pain relief, life quality and function improvement. Results Compared with the preoperation, the anterior, middle vertebral body height and kyphosis angle were significantly improved after two procedures, but the improvement efficacy seemed to be more significant in the experimental group, with no significant loss of correction effect at final follow-up. The VAS, SF-36 and ODI scores were all significantly improved postoperatively, especially at final follow-up in two groups. The neurological situation was improved in patients at least 1 grade in Frankel scale. After mean follow-up of 24 months, no operative complications (internal fixation loosening, breakage, spinal nerve damage or pneumothorax) were observed, except bone cement leakage occurred in two cases in experimental group. Conclusion Posterior decompression, bone cement augmentation and internal fixation seems to be effective and safe for pathological fractures caused by VHs, with better outcomes and few complications.