This is a retrospective study of 40 consecutive patients of OVCF who were operated from June 2015 to May 2018. Institutional ethics committee approval and informed written consent from all patients taken before conducting this study.
Inclusion criteria
- Age 60-80 years
- DEXA scan T score <−2.5
- Single level vertebral fracture
- Loss of vertebral body height ³50%
- Neurological deficit (Frankel Grade C/D)
- Minimum follow‐up 24-months
Exclusion criteria
- Other pathological fractures
- Previously operated spine patients
- Uncontrolled diabetes patients
- Highly comorbid patients
Clinical Assessment:
- Demographic data: Age, Sex, Mode of injury, Duration of injury to clinical presentation, duration of neurological deficit, Bone Density
- Pain score - Visual Analog Score [VAS]
- Modified Oswestry Disability Index [M-ODI]
- Neurology - Frankel Grade
Radiological Assessment:
Standing spine radiographs, Magnetic Resonance Imaging, and computed tomograms (CT) scan, DEXA scan.
Radiological parameters: Local kyphosis angle measured from the superior endplate of immediate, intact cephalic vertebrae, and the inferior endplate of intact caudal vertebrae [9]. Fusion status was assessed by radiographs and dedicated CT scan of the surgical area after 9-months of the surgery.
The following parameters were considered to assess the safety and efficacy of the use of sublaminar mersilene tape augmentation in OVCFs fixation.
Safety parameters
- Neurologic deficit
- Implant failure/back out
- Revision surgeries
- Infection.
Efficacy parameters
- Back pain score
- Kyphosis angle correction
- Fracture union
Surgical procedure
A standard midline posterior approach was used. After midline exposure, paraspinal muscles were elevated and retracted bilaterally from spinous processes, laminae; pars interarticularis up to the tip of transverse processes. This not only helped in the wide exposure of the interlaminar area for SMT augmentation but also assisted in preparing a good fusion bed for bone grafting.
Stage-1: ( Pedicle screw fixation, corpectomy, Decompression and fusion)
Pedicle screws were inserted in two vertebral levels above and two vertebral levels below fracture and one side connected with a connecting rod. After connecting rods and screw, bilateral hemilaminectomy at fracture level, with care to preserve medial one‐third facetectomy was performed. A subtotal corpectomy of the fractured vertebral body was performed with an osteotome and curettes, leaving the lateral and anterior vertebral body wall in place. If a retropulsed bone fragment was recognized, it was pushed anteriorly with the use of a reverse-angled curette, with great care taken to avoid retraction of the dura. By gently distracting the spinal nerve on the more severely injured side. A 2 cm incision was placed over the posterior superior iliac spine (PSIS) to harvest cancellous iliac crest autograft. A titanium mesh cage was inserted into the intervertebral space, which was of 80% to 100% length of fractured segmental height and filled with bone graft. The cage was then longitudinally aligned and set parallel to the axis of the spinal column using an impactor. The cage was placed in the center of the fractured body with the assistance of biplanar fluoroscopy. Compression was then applied across the fractured level to create a press fit for the cage. The nerve root was rechecked for any compression before placing the other rod and final tightening set caps. A crosslink was inserted in the standard fashion. Gelfoam was placed over the exposed dura.
Stage-2: Sublaminar mersilene tape augmentation
Supra/interspinous ligament and ligamentum flavum were excised, and a sublaminar space was created at each level for passing wires. After exposing the sublaminar spaces, a double loop of 20 gauge “cold cured stainless steel wires with ethibond suture at the end” was inserted around the laminae of to be instrumented cephalad and caudal vertebral levels by insertion, advancement, roll through, and pull-through technique. Needle for 35mm mersilene tape cut and removed. Mersilene tape passed through the lamina with help of an ethibond suture loop. On each side, each mersilene tape passed through the connecting rod with a cephalad end ending inside it, and a caudal end outside the connecting rod at all levels. These mersilene tapes were sequentially tightened clockwise. The extra length of mersilene tape was cut.
Posterolateral fusion with facet fusion with morselized cancellous autograft was performed. A surgical drain was inserted in all patients. Multilayer closure was performed. [Fig.1]
Statistical analysis
Patients preoperative and postoperative follow-up data collected. Statistical analysis was performed using SPSS software version 20.0 (SPSS Inc., Chicago, IL, USA) and paired Student's t‐test. Data were presented as the means ± standard deviations A value of less than 0.05 was considered statistical significance.