Anterior Placement of Cemented Fenestrated Screws in Conjunction with Anterior Reconstruction in Elderly Patients with Severe Vertebral Collapse and Paraparesis

Volume 3 | Issue 1 | April-September 2022 | page: 20-23 | Subir N. Jhaveri, Shivam K. Kiri, Sharan S. Jhaveri

DOI: 10.13107/bbj.2022.v03i01.035


Authors: Subir N. Jhaveri [1], Shivam K. Kiri [1], Sharan S. Jhaveri [1]

[1] Department of Orthopaedics, Dr. Subir Jhaveri’s Spine Hospital, Ahmedabad, Gujarat, India.

Address of Correspondence

Dr. Subir N. Jhaveri.
Department of Orthopaedics, Dr. Subir Jhaveri’s Spine Hospital, Ahmedabad, Gujarat, India.
E-mail: subirjhaveri@yahoo.com


Abstract


Background: Elderly patients with severe osteoporosis are prone to sustain osteoporotic vertebral compression fractures (OVCF’s). Sometimes, they undergo significant vertebral collapse and kyphosis, leading to significant canal compromise and neurological deterioration.
Case Description: We present a case series of three patients, of which two had OVCF’s of L1 and L3, respectively, while one patient had Koch’s spine D12 and L1. All three cases had severe vertebral collapse leading to kyphosis, severe pain, and canal compromise, neurological deterioration with paraparesis, and bowel bladder involvement. Surgery warranted total corpectomy of fractured vertebrae (anterior vertebral column resection) and reconstruction of the anterior column. Due to the significant degree of osteoporosis, fenestrated screws with bone cement (poly methyl acrylate) were used anteriorly along with vertebral body reconstruction with cage, through a purely anterior approach. This is the first instance of fenestrated screws being used anteriorly to reduce screw pull-out. In view of the strong anterior construct, a posterior surgery to supplement the fixation could be avoided in these thoracolumbar junctional cases.
Results: No patient experienced loosening of implants, nor did any patient experience cement-related complications. Although the present follow-up of these patients is short (12 months), the patients are pain free and independently ambulatory.
Conclusion: Using fenestrated screws in an anterior location allow vertebral reconstruction with a single surgery in elderly patients with severe osteoporosis, reducing chances of screw pull-out. Bone plugs at the tip to help prevent cement extravasation from the vertebral body.
Keywords: Anterior fenestrated screws, Bone cement, Corpectomy, Osteoporotic vertebral compression fracture, Koch’s spine, Screw pull-out.


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How to Cite this Article: Jhaveri SN, Kiri SK, Jhaveri SS | Anterior Placement of Cemented Fenestrated Screws in Conjunction with Anterior Reconstruction in Elderly Patients with Severe Vertebral Collapse and Paraparesis | Back Bone: The Spine Journal | April-September 2022; 3(1): 20-23.

 


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